Changes in metabolic parameters in patients with severe mental illness over a 10-year period: a retrospective cohort study
Heald, AH × Martin, L Payton, A Khalid, L Anderson, SG Narayanan, RP De Hert, Marc Yung, A Livingston, M #
Australian and New Zealand Journal of Psychiatry vol:ahead of print
Objective: To determine how anthropometric and metabolic features changed over time in a retrospective cohort of people with SMI living in Cheshire, UK.
Methods: 1,307 individuals on the SMI Register were followed up between 2002 and 2012 in UK general practice (GP). Subjects were identified through a
pseudanonymised search of GP registers.
Results: Baseline body mass index (BMI) was 28.6 kg/m2 increasing to 31.0 at 10-year follow up, (r2=0.84; p=0.0002). There was a significant increase in fasting blood
glucose (FBG) from 5.72 mmol/L to 6.79 mmol/L (r2=0.48; p=0.026. Correspondingly, there was a strong positive univariate relation between increase in
BMI and FBG (r2=0.54; p<0.0001) taking into account all measurements. FBG also increased slightly with age (p=0.028). With increasing use of statins, total cholesterol
fell from 4.5 mmol/L to 3.9 mmol/L (r2=0.88; p=0.0001), as did low-density lipoprotein-cholesterol from 3.43 mmol/L to 2.35 mmol/L (r2=0.94; p=0.0001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each
unit increase in BMI (OR=1.07 (1.01, 1.13); p=0.031) and triglycerides (OR=1.28 (1.06, 1.55); p=0.009) were independently associated with an increased risk of
having type 2 diabetes.
Conclusions: Increasing BMI relates to increasing rates of dysglycaemia over time.
Measures to encourage weight reduction should be key strategies to reduce
dysglycaemia rates in SMI. Prescribing of statins may have been effective in
improving the lipid profile in this group.