Diabetes: 2-step testing algorithm best for screening psychiatric inpatients

  • Mitchell AJ & al.
  • PLoS One
  • 1 Jan 2019

  • International Clinical Digest
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Takeaway

  • Patients with severe mental illness receiving antipsychotic medication should be screened for diabetes with a 2-step testing algorithm, rather than clinical variables.

Why this matters

  • Blood glucose is tested in only about half the patients under psychiatric care.

Study design

  • Researchers examined consecutive psychiatric inpatients receiving antipsychotics (N=798; mean age, 37.7 years; men, 61.1%), comparing biochemical and clinical predictors of diabetes.
  • Funding: EFSD/Lilly grant.

Key results

  • No single clinical factor accurately confirmed a diagnosis of diabetes.
  • Only 3 clinical factors could rule out diabetes with good accuracy: BMI (76.6% accurate), waist/hip ratio (74.2% accurate), and height (68.7% accurate).
  • The most accurate (98.5%) assessment required a 2-step algorithm consisting of HBA1c ≥5.7% followed in 32.7% of patients by both fasting glucose and oral glucose tolerance testing.

Limitations

  • Prospective data were not available on prediabetes, repeat testing, or end-organ dysfunction.

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