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首页> 外文期刊>The journal of clinical psychiatry >Elevated hemoglobin A1c as a possible indicator of diabetes mellitus and diabetic ketoacidosis in schizophrenia patients receiving atypical antipsychotics.
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Elevated hemoglobin A1c as a possible indicator of diabetes mellitus and diabetic ketoacidosis in schizophrenia patients receiving atypical antipsychotics.

机译：血红蛋白A1c升高可能是接受非典型抗精神病药的精神分裂症患者糖尿病和糖尿病酮症酸中毒的可能指标。

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OBJECTIVE: We conducted a retrospective epidemiologic study assessing the incidence of new-onset diabetes mellitus presenting as diabetic ketoacidosis in patients with schizophrenic disorders (ICD-9 295.0-295.9; referred to as "schizophrenia patients" hereafter) treated with atypical antipsychotic agents. METHOD: The identification of patients and the review of records were achieved by using an electronic database linking administrative and clinical laboratory data between January 1, 1995, and December 31, 2001. The main outcome measure was the incidence of diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome per 10,000 patient years in patients with new-onset or existing diabetes mellitus. We also determined the incidence of diabetic ketoacidosis associated with the use of atypical antipsychotics and calculated the mean hemoglobin A1c (HbA1c) level for all patients. RESULTS: During the 7-year period, 18.4% of schizophrenia patients were diagnosed with diabetes mellitus, compared with 6.6% in the general hospital population (p < .001). After chart review, 23 schizophrenia patients were identified with diabetic ketoacidosis: 11 had diabetes presenting as diabetic ketoacidosis, 8 had diabetic ketoacidosis with known diabetes mellitus, 2 had new-onset diabetes mellitus-hyperosmolar hyperglycemic syndrome, and 2 had hyperosmolar hyperglycemic syndrome with known diabetes mellitus. The incidence of diabetes presenting as diabetic ketoacidosis in schizophrenia patients was more than 10-fold higher than that reported in the general population: 14.93 per 10,000 patient years in schizophrenia patients versus 1.4 per 10,000 patient years in the general population (p < .000001) and versus the 1.98 per 10,000 patient years in the general hospital population (p < .000001). The incidence of diabetic ketoacidosis for each of atypical antipsychotic drugs over the 7-year period was as follows: clozapine, 2.2%; olanzapine, 0.8%; and risperidone, 0.2% (no incidence with ziprasidone or quetiapine). Of the 11 patientswith diabetes presenting as diabetic ketoacidosis, the mean HbA1c level at admission was 13.3% +/- 1.9% (10.4%-16.9%). CONCLUSIONS: The incidence of diabetes mellitus presenting as diabetic ketoacidosis in schizophrenia patients is higher than in the general hospital population and differs across atypical antipsychotic agents. Elevated HgbA1c levels observed suggests that patients had undiagnosed diabetes mellitus for at least several weeks before the diabetic ketoacidosis episode.
机译：目的：我们进行了一项回顾性流行病学研究，评估了接受非典型抗精神病药物治疗的精神分裂症患者（ICD-9 295.0-295.9;以下称为“精神分裂症患者”）中以糖尿病酮症酸中毒为首发的糖尿病的发病率。方法：使用电子数据库连接患者和临床实验室数据，从1995年1月1日至2001年12月31日之间进行患者识别和记录审查。主要结局指标是糖尿病性酮症酸中毒或高渗性高血糖综合征的发生率新发或现有糖尿病患者的每10,000患者年每10,000患者年。我们还确定了与使用非典型抗精神病药有关的糖尿病性酮症酸中毒的发生率，并计算了所有患者的平均血红蛋白A1c（HbA1c）水平。结果：在这7年期间，精神分裂症患者被诊断出患有糖尿病的比例为18.4％，而普通医院的这一比例为6.6％（p <.001）。经过图表审查后，确定了23例患有糖尿病酮症酸中毒的精神分裂症患者：11例以糖尿病酮症酸中毒的糖尿病，8例已知糖尿病的糖尿病酮症酸中毒，2例新发糖尿病-高渗性高血糖综合征，2例高渗性高血糖综合征糖尿病。精神分裂症患者中表现为糖尿病性酮症酸中毒的糖尿病发病率比一般人群高10倍以上：精神分裂症患者每10,000患者年14.93，而一般人群每10,000患者年1.4（p <.000001）相比之下，综合医院人口中每10,000个患者年1.98个年（p <.000001）。在7年期间，每种非典型抗精神病药物的糖尿病酮症酸中毒发生率如下：氯氮平2.2％;奥氮平0.8％;和利培酮0.2％（齐拉西酮或喹硫平无相关性）。在11名糖尿病酮症酸中毒患者中，入院时HbA1c的平均水平为13.3％+/- 1.9％（10.4％-16.9％）。结论：精神分裂症患者中表现为糖尿病性酮症酸中毒的糖尿病发病率高于普通医院人群，并且在不同的非典型抗精神病药物之间存在差异。观察到的HgbA1c水平升高表明，在糖尿病性酮症酸中毒发作之前，患者至少有几周未诊断出糖尿病。

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