The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions...

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Published in:PloS one Vol. 12; no. 1; p. e0168549
Main Authors: Taylor, Johanna, Stubbs, Brendon, Hewitt, Catherine, Ajjan, Ramzi A., Alderson, Sarah L., Gilbody, Simon, Holt, Richard I. G., Hosali, Prakash, Hughes, Tom, Kayalackakom, Tarron, Kellar, Ian, Lewis, Helen, Mahmoodi, Neda, McDermid, Kirstine, Smith, Robert D., Wright, Judy M., Siddiqi, Najma
Format: Journal Article
Language:English
Published: United States Public Library of Science 05.01.2017
Public Library of Science (PLoS)
Subjects:
Adult
Adults
Antipsychotics
Biology and Life Sciences
Blood Glucose - drug effects
Care and treatment
Clinical trials
Comparative analysis
Confidence intervals
Data processing
Diabetes
Diabetes mellitus
Diabetes Mellitus - blood
Diabetes Mellitus - drug therapy
Drug therapy
Fasting
Fasting - blood
Food and nutrition
Glucose
Glycated Hemoglobin - metabolism
Health risks
Health sciences
Hemoglobin
Heterogeneity
Humans
Insulin
Intervention (Psychology)
Laboratory testing
Life expectancy
Life span
Medicine and Health Sciences
Mental disorders
Mental Disorders - blood
Mental Disorders - drug therapy
Mentally ill persons
Meta-analysis
Metabolic diseases
Metabolism
Metformin
Metformin - therapeutic use
Pharmacology
Physical activity
Physiological aspects
Population
Psychiatry
Psychosis
Psychotropic drugs
Regression analysis
Risk assessment
Schizophrenia
Statistical analysis
Studies
Switching
Systematic review
ISSN:1932-6203, 1932-6203
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Summary:People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration's tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.
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Conceptualization: JT BS CH RA SA SG RIGH PH TH TK IK HL NM KM RS JW NS.Formal analysis: JT BS CH SA RIGH PH IK HL RS NS.Funding acquisition: NS SG HL.Investigation: JT BS CH SA RIGH PH TK IK HL NM KM RS JW NS.Methodology: JT BS CH RA SA SG RIGH PH TH TK IK HL NM KM RS JW NS.Project administration: JT.Resources: JT KM JW.Supervision: JT NS.Validation: JT BS CH RA RIGH PH TH IK NS.Visualization: JT BS NS CH.Writing – original draft: JT NS.Writing – review & editing: JT BS CH RA SA SG RIGH PH TH TK IK HL NM KM RS JW NS.
Competing Interests: I have read the journal's policy and one author has the following competing interests: RIGH has acted as an advisory board member and speaker for Novo Nordisk, and as a speaker for Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Janssen, Lundbeck, Merck Sharpe and Dohme, Otsuka and Sanofi-Aventis. All other authors declare no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0168549