CoChat
Sign Up
Cited by 660Schizophrenia research and treatmentDiabetes, Cardiovascular Risks, and LipoproteinsBipolar Disorder and Treatment

Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis

Open access
Vancampfort, Davy, Correll, Christoph U., Galling, Britta, Probst, Michel, De Hert, Marc, Ward, Philip B., Rosenbaum, Simon, Gaughran, Fiona +2 more·2016·World Psychiatry
DOI 10.1002/wps.20309PMC PMC4911762
Open this paper in CoChat — free account

Abstract

Type 2 diabetes mellitus (T2DM) is highly predictive of cardiovascular diseases and can have particularly deleterious health impacts in people with severe mental illness (SMI), i.e. schizophrenia, bipolar disorder or major depressive disorder. This meta‐analysis aimed: a) to describe pooled frequencies of T2DM in people with SMI; b) to analyze the influence of demographic, illness and treatment variables as well as T2DM assessment methods; and c) to describe T2DM prevalence in studies directly comparing persons with each specific SMI diagnosis to general population samples. The trim and fill adjusted pooled T2DM prevalence among 438,245 people with SMI was 11.3% (95% CI: 10.0%‐12.6%). In antipsychotic‐naïve participants, the prevalence of T2DM was 2.9% (95% CI: 1.7%‐4.8%). There were no significant diagnostic subgroup differences. A comparative meta‐analysis established that multi‐episode persons with SMI (N=133,470) were significantly more likely to have T2DM than matched controls (N=5,622,664): relative risk, RR=1.85, 95% CI: 1.45‐2.37, p<0.001. The T2DM prevalence was consistently elevated in each of the three major diagnostic subgroups compared to matched controls. Higher T2DM prevalences were observed in women with SMI compared to men (RR=1.43, 95% CI: 1.20‐1.69, p<0.001). Multi‐episode (versus first‐episode) status was the only significant predictor for T2DM in a multivariable meta‐regression analysis (r 2=0.52, p<0.001). The T2DM prevalence was higher in patients prescribed antipsychotics, except for aripriprazole and amisulpride. Routine screening and multidisciplinary management of T2DM is needed. T2DM risks of individual antipsychotic medications should be considered when making treatment choices.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found that approximately 11.3% of people with severe mental illness had type 2 diabetes, with multi-episode SMI patients about 1.85 times more likely to have T2DM than matched general population controls. T2DM prevalence did not differ significantly across schizophrenia, bipolar disorder, and major depressive disorder diagnostic subgroups.

Key findings

  • Trim-and-fill adjusted pooled T2DM prevalence among 438,245 people with SMI was 11.3% (95% CI 10.0–12.6); in antipsychotic-naïve participants it was 2.9% (95% CI 1.7–4.8).
  • Multi-episode SMI (N=133,470) had significantly higher T2DM than matched controls (N=5,622,664): RR=1.85, 95% CI 1.45–2.37, p<0.001; diagnostic subgroup RRs vs controls were 2.04 for schizophrenia/related psychoses, 1.89 for bipolar disorder, and 1.43 for MDD.
  • Women with SMI had higher T2DM prevalence than men (RR=1.43, 95% CI 1.20–1.69, p<0.001); multi-episode vs first-episode status was the only significant predictor in multivariable meta-regression (r²=0.52, p<0.001).
  • Except for aripiprazole and amisulpride, all individual antipsychotics had significantly higher T2DM risk than antipsychotic-naïve participants; North America had higher prevalence (12.5%) than Europe (7.7%, p<0.001).

Methods

  • Systematic review/meta-analysis following MOOSE and PRISMA; searched Medline, PsycARTICLES, Embase, and CINAHL from inception to August 1, 2015, without language restrictions.
  • Included observational studies and RCTs in adults with DSM-IV-TR/ICD-10 schizophrenia or related psychotic disorders, bipolar disorder, or MDD that reported study-defined T2DM prevalences; 118 publications with 135 T2DM prevalences were included.
  • Random-effects meta-analysis; relative risks for direct within-study comparisons; subgroup analyses and meta-regressions for demographic, illness, treatment, assessment, and geographic moderators; publication bias assessed with Egger/Begg tests and trim-and-fill.

Limitations

  • Stated: few studies used oral glucose tolerance testing as the gold standard; chart reviews carry selection bias and diagnostic reliability/validity concerns; mostly cross-sectional data prevent certainty about directionality of the medication–T2DM association; clinical subtypes of MDD/bipolar disorder were not controlled; publication bias and heterogeneity were encountered, though trim-and-fill adjusted for bias and the multivariable model explained over half of between-study heterogeneity; inadequate lifestyle behavior data.
  • Stated: only a minority of studies provided mean age by sex, so women with schizophrenia may have been older, potentially confounding the higher T2DM risk in women.
  • Evident from text (not listed among stated limitations): many analyses relied on self-report or chart review rather than blood testing, and antipsychotic risk comparisons may be affected by order effects, such as switching from higher-risk agents.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/wps.20309

Cites

53 of 53 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 37 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There were no significant diagnostic subgroup differences in T2DM prevalence.

    “There were no significant diagnostic subgroup differences.”
    • Also stated in: § DISCUSSION · plain
      “comparative meta-analyses found no significant differences across schizophrenia, schizophrenia spectrum disorders, bipolar disorder and MDD.”
    Quote in the paperSubstantial claim
  • Findingown data

    T2DM prevalence was consistently elevated in each of the three major diagnostic subgroups compared to matched controls.

    “The T2DM prevalence was consistently elevated in each of the three major diagnostic subgroups compared to matched controls.”
    • Also stated in: § DISCUSSION · plain
      “T2DM prevalences were consistently elevated for each of the three diagnostic subgroups compared to the general population”
    Quote in the paperSubstantial claim
  • Findingown data

    The trim and fill adjusted pooled T2DM prevalence among 438,245 people with SMI was 11.3% (95% CI 10.0%-12.6%).

    “The trim and fill adjusted pooled T2DM prevalence among 438,245 people with SMI was 11.3% (95% CI: 10.0%-12.6%).”
    • Also stated in: § T2DM prevalence · plain
      “Applying the trim and fill method, adjusting for 13 studies, the prevalence of T2DM was 11.3% (95% CI: 10.0%-12.6%).”
    • Also stated in: § DISCUSSION · plain
      “Approximately one in 10 individuals with SMI (11.3%; 95% CI: 10.0%-12.6%)had T2DM”
    Quote in the paperSubstantial claim
  • Findingown data

    In antipsychotic-naive participants, the prevalence of T2DM was 2.9% (95% CI 1.7%-4.8%).

    “In antipsychotic-na€ ıve participants, the prevalence of T2DM was 2.9% (95% CI: 1.7%-4.8%).”
    • Also stated in: § Medication use · plain
      “The prevalence of T2DM was lowest in antipsychotic-na€ ıve participants (2.9%, 95% CI: 1.7%-4.8%).”
    Quote in the paperSubstantial claim
  • Findingown data

    Multi-episode (versus first-episode) status was the only significant predictor for T2DM in a multivariable meta-regression analysis (r2=0.52, p<0.001).

    “Multi-episode (versus first-episode) status was the only significant predictor for T2DM in a multivariable meta-regression analysis (r 2 50.52, p<0.001).”
    Quote in the paperSubstantial claim
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 29

  • May combine two claims.

    Findingown data

    T2DM prevalence was higher in patients prescribed antipsychotics, except for aripiprazole and amisulpride.

    “The T2DM prevalence was higher in patients prescribed antipsychotics, except for aripriprazole and amisulpride.”
    • Also stated in: § Medication use · plain
      “Except for aripiprazole and amisulpride, all individual antipsychotics had significantly (p<0.05)higher T2DM risk compared to antipsychotic-na€ ıve participants”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    There are differences in T2DM prevalences across assessment methods.

    “As there are differences in T2DM prevalences across assessment methods”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Patient self-report yielded numerically the lowest T2DM prevalences; the T2DM prevalence was significantly lower compared with chart review data.

    “Finally, as expected, patient self-report yielded numerically the lowest T2DM prevalences; the T2DM prevalence was significantly lower compared with chart review data.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Twenty papers, including 64 analyses, reported on antipsychotics (monotherapy) and T2DM frequencies.

    “Twenty papers, including 64 analyses, reported on antipsychotics (monotherapy) and T2DM frequencies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    44.5% (95% CI 29.2%-60.4%) of included participants smoked.

    “Thirty-one studies (N577,028) reported smoking frequencies, and 44.5% (95% CI: 29.2%-60.4%) of the included participants smoked.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were no data in first-episode bipolar disorder or MDD patients, precluding a comparison with multi-episode patients.

    “There were no data in firstepisode bipolar disorder or MDD patients, precluding a comparison with multi-episode patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Separate meta-regression analyses revealed that higher T2DM frequencies were moderated by older age, longer illness duration, and first-episode versus multi-episode status, but not by gender, ethnicity, and smoking status.

    “Separate meta-regression analyses (see Table 2) revealed that higher T2DM frequencies were moderated by older age, longer illness duration, and first-episode versus multiepisode status, but not by gender, ethnicity, and smoking status.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The search yielded 323 publications, of which 118 (including 135 T2DM prevalences) met inclusion criteria.

    “After excluding duplicates and irrevelant hits, our search yielded 323 publications, of which 118 (including 135 T2DM prevalences) met inclusion criteria (Figure 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    56.8% of participants with SMI were male (range 0-100).

    “56.8% were male (range 0-100)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    69% of participants with SMI were Caucasian (range 0-100; 37 studies).

    “69% were Caucasian (range 0-100; 37 studies)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the current meta-analysis, quetiapine (and a trend for clozapine) was associated with an even higher T2DM risk than olanzapine use.

    “In the current meta-analysis, quetiapine (and a trend for clozapine) was associated with an even higher T2DM risk than olanzapine use.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Mean illness duration was 16.1 years (range 0-35 years; 29 studies).

    “Mean illness duration was 16.1 years (range 0-35 years; 29 studies).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Treatment duration, percentage of antidepressant use and percentage of lithium use, but not percentage of other mood stabilizers use, were significant mediators of T2DM prevalence.

    “Separate meta-regression analyses (see Table 2) showed that treatment duration, percentage of antidepressant use and percentage of lithium use, but not percentage of other mood stabilizers use, were significant mediators of T2DM prevalence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Thirty-four studies provided data on T2DM prevalences comparing multi-episode patients with healthy control subjects, and three studies compared first-episode schizophrenia patients with controls.

    “Thirty-four studies provided data on T2DM prevalences comparing multi-episode patients with healthy control subjects, and three studies compared first-episode schizophrenia patients with controls.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A trend for higher T2DM was found in retrospective studies versus cross-sectional (p=0.054) and versus prospective (p=0.053) studies.

    “A trend for higher T2DM was found in retrospective studies versus cross-sectional (p50.054) and versus prospective (p50.053)studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Except for a higher risk for quetiapine versus olanzapine (p=0.04), no differences in risk profile between individual medications were found.

    “Except for a higher risk for quetiapine versus olanzapine (p50.04),we did not find any differences in risk profile between individual medications.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were no significant differences between various treatment settings, and data collection before versus after the year 2000.

    “There were no significant differences between the various treatment settings, and data collection before versus after the year 2000.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The mean age of participants with SMI was 44.3 years (range 23.1-77.6 years).

    “The mean age of participants with SMI was 44.3 years (range 23.1-77.6 years)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent reviewers searched databases and screened titles/abstracts, with a third reviewer available for mediation.

    “Two independent reviewers (DV, BS) searched Medline, Psyc-ARTICLES, Embase and CINAHL from database inception to August 1, 2015, without language restrictions.”
    • Also stated in: § Search criteria, study selection and critical appraisal · plain
      “After the removal of duplicates, the reviewers screened the titles and abstracts of all potentially eligible articles.They both applied the eligibility criteria, and a list of full text articles was developed through consensus.”
    • Also stated in: § Search criteria, study selection and critical appraisal · plain
      “A third reviewer (CC) was available for mediation throughout this process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    T2DM is a major risk factor for CVD.

    “Type 2 diabetes mellitus (T2DM) is a major risk factor for CVD.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] source

      Not checked in the free run.

    • cites [14] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    T2DM confers about a two-fold excess risk for coronary heart disease, major stroke subtypes, and deaths attributed to other vascular causes.

    “It confers about a two-fold excess risk for coronary heart disease, major stroke subtypes, and deaths attributed to other vascular causes 13,14 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] source

      Not checked in the free run.

    • cites [14] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Methodological appraisal included evaluation of bias (confounding, overlapping data, publication bias).

    “Methodological appraisal included evaluation of bias (confounding, overlapping data, publication bias).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The mortality gap translates to a 10-20 year shortened life expectancy.

    “This mortality gap translates to a 10-20 year shortened life expectancy 3,4”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] source

      Not checked in the free run.

    • cites [4] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Publication bias was tested using Egger's regression method and Begg-Mazumdar test.

    “Publication bias was tested using the Egger's regression method 23 and Begg-Mazumdar test 24 , with a p-value <0.05 suggesting the presence of bias.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [23] source

      Not checked in the free run.

    • cites [24] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The systematic review was conducted in accordance with MOOSE guidelines and PRISMA standard.

    “This systematic review was conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines 21 and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard 22 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] source

      Not checked in the free run.

    • cites [22] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    People with SMI have a two to three times higher risk for premature death than the general population.

    “People with severe mental illness (SMI) -defined as schizophrenia, bipolar disorder or major depressive disorder (MDD)have a two to three times higher risk for premature death than the general population 1,2 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source

      Not checked in the free run.

    • cites [2] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    When publication bias was encountered, a trim and fill adjusted analysis was conducted.

    “When we encountered publication bias, we conducted a trim and fill adjusted analysis 25 to remove the most extreme small studies from the positive side of the funnel plot, and recalculated the effect size iteratively, until the funnel plot was symmetrical around the (new) effect size.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Variations in the risk for glucose abnormalities are evident in the literature, with the highest risk being associated with clozapine, olanzapine and quetiapine in carefully designed studies.

    “Variations in the risk for glucose abnormalities are evident in the literature, with the highest risk being associated with clozapine, olanzapine and quetiapine in carefully designed studies 25,34,35 .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [25] source

      Not checked in the free run.

    • cites [34] source

      Not checked in the free run.

    • cites [35] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Only comparisons of specific SMI groups or SMI with matched general population performed within the same study were included to minimize variability.

    “In both analyses, only comparisons of specific SMI groups or a SMI group with a matched general population group were included that had been performed within the same study, in order to minimize variability of T2DM frequencies due to different sampling and assessment procedures.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Diagnostic and gender differences were not calculated across studies; only data of studies comparing these differences on a patient level were pooled.

    “In order to reduce heterogeneity, we did not calculate diagnostic and gender differences across studies, but pooled only data of studies that compared these differences on a patient level.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Screening for T2DM and cardiovascular disease (CVD) risk factors is still suboptimal, with only slight improvement over the last decade.

    “screening for T2DM and CVD risk factors is still suboptimal, with only slight improvement over the last decade 12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The higher risk for T2DM in women with SMI than men may be related to a greater propensity to obesity and central obesity in women with SMI compared to men, since central obesity is a significant risk factor for hyperglycaemia.

    “This finding warrants further investigation, but may be related to a greater propensity to obesity and central obesity in women with SMI compared to men 32 , since central obesity is a significant risk factor for hyperglycaemia.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Professional barriers to screening within mental health settings reflect lack of clarity about clinical responsibility, lack of understanding about what should be measured and when, uncertainty about how to interpret results, lack of access to necessary equipment, and incomplete communication between primary and secondary care.

    “Professional barriers to screening within mental health settings may in their turn reflect lack of clarity about whose clinical responsibility the screening is, lack of understanding about what should be measured and when, uncertainity about how to interpret results, and lack of access to necessary equipment 41 , as well as incomplete communication between primary and secondary care.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Other diagnostic-independent factors likely influence T2DM frequency, including hyperglycaemia following psychotropic medication use and long-term exposure to unhealthy lifestyle behaviors, as well as potential genetic factors linking psychiatric and medical risk.

    “Thus, other diagnosticindependent factors likely influence T2DM frequency, including hyperglycaemia following psychotropic medication use 26 and long-term exposure to unhealthy lifestyle behaviors 27,28 , as well as potential genetic factors linking psychiatric and medical risk 29 .”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [26] source

      Not checked in the free run.

    • cites [27] source

      Not checked in the free run.

    • cites [28] source

      Not checked in the free run.

    • cites [29] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Only a minority of analyzed studies provided information about the mean age in women and men, and it is possible that women with schizophrenia were older, which could have confounded the results.

    “On the other hand, only a minority of analyzed studies did provide information about the mean age in women and men, and it is possible that women with schizophrenia were older, which could have confounded the results.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    This finding should be interpreted with caution, as order effects cannot be excluded, in that patients who acquired marked T2DM risk or developed even frank T2DM on a higher-risk agent, such as olanzapine, could have been switched to another antipsychotic, including quetiapine, potentially leading to risk misattribution.

    “However, this finding should be interpreted with caution, as order effects cannot be excluded, in that patients who acquired marked T2DM risk or developed even frank T2DM on a higher-risk agent, such as olanzapine, could have been switched to another antipsychotic, including quetiapine, potentially leading to risk misattribution.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other antidepressants, including tricyclic antidepressants, may exacerbate glycaemic dysfunction or have little effect on glucose homeostasis.

    “whereas others, including tricyclic antidepressants, may exacerbate glycaemic dysfunction or have little effect on glucose homeostasis 46,47”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] source

      Not checked in the free run.

    • cites [47] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Some antidepressants may, in some circumstances, reduce hyperglycaemia, normalize glucose homeostasis and increase insulin sensitivity.

    “previous studies 45 found that some antidepressants may, in some circumstances, reduce hyperglycaemia, normalize glucose homeostasis and also increase insulin sensitivity”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Emerging evidence suggests that SMI and T2DM share some pathophysiological features, including hypothalamic-pituitary-adrenal and mitochondrial dysfunction, neuro-inflammation, common genetic links and epigenetic interactions.

    “Emerging evidence 48 suggests that SMI and T2DM share some pathophysiological features, including hypothalamic-pituitary-adrenal and mitochondrial dysfunction, neuro-inflammation, common genetic links and epigenetic interactions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Without systematic screening following detailed recommendations and using acceptable and accurate diagnostic tests, the true prevalence of T2DM in patients with SMI will remain unknown and underestimated.

    “Without systematic screening following detailed recommendations and using acceptable and accurate diagnostic tests, the true prevalence of T2DM in patients with SMI will remain unknown and underestimated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    When T2DM is detected, people with SMI are likely to require additional pharmacological management, but this is unlikely to be significantly different from the general population.

    “When T2DM is detected, people with SMI are likely to require additional pharmacological management, but this is unlikely to be significantly different from the general population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Any deterioration in mental health may result in compromised management of T2DM, and comprehensive management may require an adjustment to the diabetes care plan.

    “However, clinicians should be aware that any deterioration in mental health may result in compromised management of T2DM, and comprehensive management may require an adjustment to the diabetes care plan.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Antipsychotic medications are increasingly used as first line treatments for bipolar disorder and MDD.

    “Since antipsychotic medications are increasingly used as first line treatments for bipolar disorder 43 and MDD 44”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [43] source

      Not checked in the free run.

    • cites [44]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The meta-analysis encountered publication bias and heterogeneity in most analyses.

    “a threat to the validity of any meta-analysis is publication bias and heterogeneity, which we encountered in most of our analyses.”
    Quote in the paperNot a substantial claim
44 of 44

  • The paper relies on this without support.

    Meta-analytic data comparing T2DM risks across different psychiatric diagnoses are currently lacking.

    “However, meta-analytic data comparing T2DM risks across different psychiatric diagnoses are currently lacking.”

  • The paper relies on this without support.

    There are no meta-analytic data that combine all major diagnostic SMI subgroups.

    “Furthermore, there are no meta-analytic data that combine all major diagnostic SMI subgroups”

  • The paper relies on this without support.

    Information on the prevalence of T2DM among people with SMI prescribed different antipsychotic medication classes is insufficient.

    “and information on the prevalence of T2DM among people with SMI prescribed different antipsychotic medication classes is insufficient.”

  • The paper relies on this without support.

    Using chart reviews has inherent problems with selection bias and the reliability and validity of T2DM diagnosis.

    “There are inherent problems with using chart reviews in relation to se-lection bias and the reliability and validity of the T2DM diagnosis.”

  • The paper relies on this without support.

    The pathophysiology underlying the association between SMI and T2DM is complex and not well understood.

    “the pathophysiology underlying the association between SMI and T2DM is complex and not well understood, requiring further investigation.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • People with severe mental illness have higher levels of somatic comorbidities and premature mortality than the general population.

    “People with severe mental illness (schizophrenia, bipolar disorder or major depressive disorder) have higher levels of somatic comorbidities and premature mortality than the general population 1-3 .”

    From Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis (2017) · cites this paper as [3]

    The Abstract states that people with severe mental illness have a two- to threefold higher risk of premature death than the general population. The Discussion finds elevated type 2 diabetes prevalence in the three diagnostic groups, supporting a higher level of one somatic comorbidity, but the paper does not establish the broader claim about somatic comorbidities generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • MDD relative-risk confidence interval conflicts with its p-value

    Major

    The reported 95% confidence interval for the MDD relative risk includes 1, but the reported p-value of 0.029 indicates significance at the 0.05 level.

    Reported 0.029 · recomputed -1.37

  • Conflicting numbers of studies comparing multi-episode patients with controls

    Minor

    The section says 34 studies compared multi-episode patients with controls, but describes the pooled multi-episode comparison as comprising 38 studies.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. World Health Organization, 1999, Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus
  2. International Diabetes Federation. IDF diabetes atlas. Sixth edition update. Brussels: International Diabetes Federation 2014.

Cited by

Sorted by citations

Related

Authors
Vancampfort, D., Correll, C. U., Galling, B., Probst, M., De Hert, M., Ward, P. B., Rosenbaum, S., Gaughran, F., Lally, J., & Stubbs, B.
Affiliations
  • KU Leuven (BE)
  • Hofstra University (US)
  • Zucker Hillside Hospital (US)
  • KU Leuven ‐ University of Leuven, Z.org KU Leuven Kortenberg Belgium
  • UNSW Sydney (AU)
  • King's College London (GB)
ORCID
Venue
World Psychiatry
Publisher
Wiley
Published
2016-06
Volume
15
Issue
2
Pages
166-174
ISSN
  • 1723-8617 (ISSN-L)
  • 2051-5545
DOI
10.1002/wps.20309
PMC
PMC4911762
OpenAlex
W2414864695
Semantic Scholar
ed66999de667844601bb084a362cd63d6d85944f
Cited by
659
References
53
Citations by year
2026: 52 · 2025: 55 · 2024: 42 · 2023: 70 · 2022: 54 · 2021: 92 · 2020: 71 · 2019: 75 · 2018: 73 · 2017: 57 · 2016: 17
FWCI
10.63
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 4 d)
Locations
  • World Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • Lirias (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
type 2 diabetes, severe mental illness, schizophrenia, bipolar disorder, major depressive disorder, antipsychotic drugs, diabetes prevalence, sex differences, aripiprazole, amisulpride, diabetes screening, cardiovascular risk

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review