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Authors
Carita Caple, RN, BSN, MSHS
Cinahl Information Systems, Glendale, CA
Tanja Schub, BS
Cinahl Information Systems, Glendale, CA
Reviewers
Darlene Strayer, RN, MBA
Cinahl Information Systems, Glendale, CA
Eliza Schub, RN, BSN
Cinahl Information Systems, Glendale, CA
Nursing Practice Council
Glendale Adventist Medical Center,
Glendale, CA
Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA
BD(9)
Depression is thought to predict the onset of many medical conditions, including
DM2(3,4,5,10,12)
Research reports indicate that the prevalence of DM2 is 34 times higher among patients
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or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
- Authors of a recent meta-analysis of 10 studies including 42,363 participants found that the presence of depression in
patients with DM2 increased risk of mortality by 50%(12)
The association between depression and DM2 may be attributable to a common etiologic process rather than a
cause-and-effectrelationship(7)
For example, low birth weight and childhood adversity are risk factors for developing both depression and DM2 later in
life
Use of certain psychotropic medications is associated with increased risk for DM2(1,4,6,11,13)
Some antipsychotic medications are associated with hyperglycemia, hyperlipidemia, obesity, and increased risk for
new-onsetDM2(2,4,6,11,13)
Certain antipsychotic drugs (e.g., second-generationantipsychotic agents; e.g., cloZAPine, OLANZapine, risperiDONE,
QUEtiapine) used in the treatment of psychological disorders that can cause weight gain as a side effect; however, no
direct relationship has been established between treatment-related weight gain and the development of DM2(2,13)
It is widely thought that many antipsychotic medications are associated with insulin resistance and impaired insulin
secretion(2,11,13)
Authors of a systematic review and meta-analysis published in 2008 found preliminary evidence that, compared to
first-generation antipsychotic agents, the second-generationantipsychotic agents cloZAPine, OLANZapine, risperiDONE,
and QUEtiapine are associated with a small increased risk of DM2 in patients with schizophrenia. They recommend
that all patients receiving any type of antipsychotic agent for treatment of schizophrenia undergo regular screening for
DM2(13)
Successful treatment of psychiatric conditions in patients with DM2 may result in increased adherence to the prescribed
treatment regimen for glycemic control(2,8)
Patients with high-risk psychiatric conditions should be routinely screened for DM2 even when antipsychotic medications
are not prescribed(2,9)
Patients should be fully informed of the risks of antipsychotic medications(9)
Individualized advice on healthy lifestyle choices should be given to all patients(2,6,8)
Risk-reduction strategies (e.g., lifestyle changes, including diet and exercise) for DM2 used in the general population may
not be effective in patients with a psychiatric diagnosis; patients with a psychiatric diagnosis often lack motivation to be
involved in their own care and to change unhealthy behavior patterns
What We Can Do
Learn about the increased risk of DM2 in patients with certain psychiatric conditions so you can accurately assess your
patients personal characteristics and health education needs; share this information with your colleagues
Collaborate with your hospitals continuing medical education department to provide education for all clinicians regarding
the increased risk of DM2 in patients with specific psychiatric diagnoses, appropriate screening, and patient education(9)
Encourage discussion about the need for close communication regarding patient care among mental health, primary care,
and DM2 specialist clinicians(8)
Alert clinicians regarding any medication warnings from drug manufacturers describing increased risk associated with
DM2, appropriate monitoring, and treatment(9)
Educate your patients that depression and anger are common in individuals coping with chronic disease, that effective
treatment for both DM2 and psychiatric conditions is available, and that improvement of medical outcomes and
psychological well-being are usual treatment results(8)
Help your patients identify ways that anger and depression can become barriers to DM2 self-management as well as steps
to overcome these barriers
Educate about lifestyle changes to improve health, including attention to weight management through diet and exercise(9)
Encourage your patients to ask their primary care or specialist clinician for a referral to a mental health clinician for
appropriate treatment of any psychiatric signs and symptoms; encourage your patients to ask their mental health clinician for
a referral to a DM2 specialist clinician if they are concerned about DM2 risk factors
Coding Matrix
References are rated using the following codes, listed in order of strength:
M Published meta-analysis
SR Published systematic or integrative literature review
RCT Published research (randomized controlled trial)
R Published research (not randomized controlled trial)
G Published guidelines
References
1. Bresee, L. C., Majumdar, S. R., Patten, S. B., & Johnson, J. A. (2010). Diabetes, cardiovascular disease, and health care use in people with and without schizophrenia.
European Psychiatry, 26(5), 327-332. (R)
2. De Hert, M., Dekker, J. M., Wood, D., Kahl, K. G., Holt, R. I., & Mller, H. J. (2009). Cardiovascular disease and diabetes in people with severe mental illness position
statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology
(ESC). European Psychiatry, 24(6), 412-424. (X)
3. Demakakos, P., Pierce, M. B., & Hardy, R. (2010). Depressive symptoms and risk of type 2 diabetes in a national sample of middle-aged and older adults: The English
longitudinal study of aging. Diabetes Care, 33(4), 792-797. (R)
4. DynaMed. (2013, July 1). Risk factors for diabetes mellitus type 2. Ipswich, MA: EBSCO Publishing. Retrieved July 25, 2013, from http://search.ebscohost.com/login.aspx?
direct=true&db=dme&AN=270053 (GI)
5. Golden, S. H., Lazo, M., Carnethon, M., Bertoni, A. G., Schreiner, P. J., Diez Roux, A. V., & Lyketsos, C. (2008). Examining a bidirectional association between depressive
symptoms and diabetes. JAMA, 299(23), 2751-2759. (R)
6. Hultsj, S. M., & Hjelm, K. (2012). Organizing care for persons with psychotic disorders and risk of or existing diabetes mellitus type 2. Journal of Psychiatric & Mental Health
Nursing, 19(10), 891-902. doi:10.1111/j.1365-2850.2012.01874.v (SR)
7. Kivimki, M., Tabk, A. G., Lawlor, D. A., Batty, G. D., Singh-Manoux, A., Jokela, M., & Vahtera, J. (2010). Antidepressant use before and after the diagnosis of type 2
diabetes: A longitudinal modeling study. Diabetes Care, 33(7), 1471-1476. (R)
8. Kreyenbuhl, J., Dixon, L. B., McCarthy, J. F., Soliman, S., Ignacio, R. V., & Valenstein, M. (2010). Does adherence to medications for type 2 diabetes differ between individuals
with versus without schizophrenia?. Schizophrenia Bulletin, 36(2), 428-435. (R)
9. Lee, N. Y., Kim, S. H., Cho, B., Lee, Y. J., Chang, J. S., Kang, U. G., & Ahn, Y. M. (2010). Patients taking medications for bipolar disorder are more prone to metabolic
syndrome than Korea's general population. Progress in Neuro-psychopharmacology and Biological Psychiatry, 34(7), 1243-1249. (R)
10. Lin, E. H., Rutter, C. M., Katon, W., Heckbert, S. R., Ciechanowski, P., Oliver, M. M., & von Korff, M. (2010). Depression and advanced complications of diabetes: A prospective
cohort study. Diabetes Care, 33(2), 264-269. (R)
11. Ogawa, M., Miyamoto, Y., & Kawakami, N. (2011). Factors associated with glycemic control and diabetes self-care among outpatients with schizophrenia and type 2 diabetes.
Archives of Psychiatric Nursing, 25(1), 63-73. (R)
12. Park, M., Katon, W. J., & Wolf, F. M. (2013). Depression and risk of mortality in individuals with diabetes: A meta-analysis and systematic review. General Hospital Psychiatry,
35(3), 217-225. doi:10.1016/j.genhosppsych.2013.01.006 (M)
13. Smith, M., Hopkins, D., Peveler, R. C., Holt, R. I., Woodward, M., & Ismail, K. (2008). First- v. second-generation antipsychotics and risk for diabetes in schizophrenia:
Systematic review and meta-analysis. British Journal of Psychiatry, 192(6), 406-411. (M)