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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Vydáno v:	PloS one Ročník 12; číslo 1; s. e0168549
Hlavní autoři:	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
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 05.01.2017 Public Library of Science (PLoS)
Témata:	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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Shrnutí:	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.
Bibliografie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Feature-2 content type line 23 ObjectType-Review-1 ObjectType-Article-3 ObjectType-Undefined-4 ObjectType-Article-1 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