Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews
Open accessAbstract
Aims/hypothesis Estimates of the global prevalence of type 2 diabetes vary between 6% and 9%. The prevalence of type 2 diabetes has been investigated in psychiatric populations but a critical appraisal of the existing evidence is lacking, and an overview is needed. This umbrella review summarises existing systematic reviews of observational studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder.Methods We searched PubMed, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews from inception to 17 January 2021 and screened reference lists of included systematic reviews. On the basis of prespecified criteria, we included systematic reviews investigating the prevalence of type 2 diabetes in adults (aged ≥18 years) with a psychiatric disorder. Titles and abstracts of 5155 identified records and full texts of 431 selected studies were screened by two independent reviewers, based on predefined eligibility criteria and an a priori developed extraction form, following the PRISMA and MOOSE guidelines. Risk of bias was assessed with the ROBIS instrument. Data extracted from primary studies were synthesised using random-effects meta-analyses.Results A total of 32 systematic reviews with 245 unique primary studies were identified and met inclusion criteria. Twelve had low risk of bias. They reported type 2 diabetes prevalence estimates ranging from 5% to 22% depending on the specific psychiatric disorder. We meta-analysed data for ten categories of psychiatric disorders and found the following prevalence estimates of type 2 diabetes: in people with a sleep disorder: 40%; binge eating disorder: 21%; substance use disorder: 16%; anxiety disorder: 14%; bipolar disorder: 11%; psychosis: 11%; schizophrenia: 10%; a mixed group of psychiatric disorders: 10%; depression: 9%; and in people with an intellectual disability 8%. All meta-analyses revealed high levels of heterogeneity.Conclusions/interpretation Type 2 diabetes is a common comorbidity in people with a psychiatric disorder. Future research should investigate whether routine screening for type 2 diabetes and subsequent prevention initiatives for these people are warranted. PROSPERO registration no. CRD42020159870.
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Psychiatric disorders, including disordered eating behaviors, are common, often unrecognized, and contribute to poor outcomes in diabetes.
“Psychiatric disorders, including disordered eating behaviors, are common, often unrecognized, and contribute to poor outcomes in diabetes (32).”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [32]
The Introduction says psychiatric disorders are common, and the Conclusions identify type 2 diabetes as a common comorbidity in people with psychiatric disorders, including binge eating disorder. The paper does not establish that psychiatric disorders are often unrecognized in people with diabetes or that they contribute to poor diabetes outcomes. Its discussion of underdiagnosis concerns diabetes in people with psychiatric disorders, not the reverse. (LLM, conf=0.85)
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The role of mental disorders in precision medicine for diabetes: a narrative review
Kremers, S., Wild, S., Elders, P., Beulens, J., Campbell, D., Pouwer, F., Lindekilde, N., de Wit, M., Lloyd, C., & Rutters, F. (2022) · Diabetologia · doi:10.1007/s00125-022-05738-x · Cited by 15 · see citing works
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“9% in the general population) [15, 16], and a two-fold risk of development compared to psychiatrically healthy people [17].”
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Cognitive deficits among people with schizophrenia and prediabetes or diabetes
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“However, they will be affected by clinical confounding factors, such as smoking [11], obesity [12], long-term use of anti-schizo-phrenic drugs [13], diabetes [14], physical activity [15], and alcohol consumption [16].”
Dragašek, J., Minár, M., Valkovič, P., & Pallayová, M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1208551 · Cited by 11 · see citing works
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Mansour, A., Abadi, A. D. N., Etesam, F., Danaei, S., Abaszadeh, Y., Torabi, F., Murshed, A., Nasli‐Esfahani, E., Vahabi, Z., & Sajjadi‐Jazi, S. M. (2025) · European journal of medical research · doi:10.1186/s40001-025-02871-2 · Cited by 7 · see citing works
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“Individuals suffering from serious mental disorders, such as schizophrenia and bipolar disorder, are more likely to develop T2DM than the general population [21].”
Mikkelsen, T. J., Agerskov, H., Jensen, D. M., Stenager, E. N., & Rothmann, M. J. (2024) · Journal of Clinical Nursing · doi:10.1111/jocn.17001 · Cited by 7 · see citing works
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Self-citationKetogenic diet, adenosine, and dopamine in addiction and psychiatry
Ruskin, D. N., Martinez, L. A., & Masino, S. A. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1492306 · Cited by 6 · see citing works
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Self-citationFlores-Ortiz, R., Fiaccone, R. L., Leyland, A. H., Millett, C. J., Hone, T., Schmidt, M. I., Ferreira, A. J. F., Ichihara, M. Y., Teixeira, C. S. S., Sanchez, M. N., et al. (2023) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2022-003224 · Cited by 6 · see citing works
“Finally, the results presented in this study suggest the need to intensify diabetes prevention and control actions and prompt treatment of the diabetes complications among”
Wang, Z., Wang, Y., Shang, W., Liu, W., Lu, C., Huang, J., Lei, C., Chen, Z., Yang, K., Yang, K., et al. (2023) · European Journal of Clinical Nutrition · doi:10.1038/s41430-023-01383-8 · Cited by 6 · see citing works
“…on these fi ndings, all stakeholders (investigators of original studies and SRs, editors, and peer reviewers) must make efforts to improve the quality and strengthen the robustness of future relevant SRs, further underpinning the evidence base for supporting clinical decisions and health policies.”
Arnautovska, U., Ritchie, G., Soole, R., Baker, A., Korman, N., Bialkowski, A., Siskind, D. J., & Milton, A. C. (2026) · BJPsych Open · doi:10.1192/bjo.2025.10954 · Cited by 5 · see citing works
“…and schizophrenia-related disorders (SSD) experience a higher prevalence of metabolic risk factors including obesity, 1 suboptimal diet and sedentary lifestyle, 2 as well as lack of health education, 3 contributing to high rates of type 2 diabetes (T2D) 4 and cardiometabolic-driven mortality.”
Moreno, E. V., Ortiz, M. T. A., Sánchez, F. J., García‐Palacios, A., Monreal‐Bartolomé, A., Gili, M., García‐Campayo, J., & Mayoral, F. (2024) · JMIR mhealth and uhealth · doi:10.2196/55483 · Cited by 6 · see citing works
“Their comorbidity has been reported in the previous literature in numerous studies [6-12].”
ResultThe causal relationship between severe mental illness and risk of lung carcinoma
Chen, X., Wang, S., & Shen, W. (2024) · Medicine · doi:10.1097/md.0000000000037355 · Cited by 5 · see citing works
“Additionally, observational studies are subjected to confounding variables such as smoking, [10] alcohol consumption, [11] physical activity, [12] obesity, [13] diabetes, [14] and the influence of antipsychotic medications on SMI treatment.”
BackgroundMadsen, N. M., Sørensen, M. A., Danielsen, A. A., Højlund, M., Rohde, C., & Köhler‐Forsberg, O. (2024) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13760 · Cited by 5 · see citing works
“9 Furthermore, we find that antipsychotics do not appear to affect HbA1c levels for most patients during the initial years of treatment.”
Fang, Y., Lee, W.-Y., Lin, C., Cheah, Y. C., Hsieh, H., Chen, C., Tsai, F., Tien, N., & Lim, Y.-P. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06222-z · Cited by 5 · see citing works
“A systemic report revealed that, the prevalence of T2DM was estimated to range from 5 to 22%, depending on the psychiatric disorder [7].”
BackgroundEbrahimi, M., Thompson, P. M., Kafashan, Z., Ceriello, A., Kolko, M., & Grauslund, J. (2025) · Journal of Endocrinological Investigation · doi:10.1007/s40618-025-02600-w · Cited by 5 · see citing works
“Psychiatric disorders: Diabetes elevates the risk of psychiatric disorders, which are physiologically linked to the brain [59].”
Anxiety and Depression Among Patients with Diabetes in Saudi Arabia and Egypt
Mahmoud, M. R., Aljadani, A., Mahmood, A. A. R., Alshammari, R. F., Shahien, M. M., Ibrahim, S., Khalik, A. A., Alenazi, F., Alreshidi, F. S., Nasr, F. M., et al. (2024) · Healthcare · doi:10.3390/healthcare12212159 · Cited by 6 · see citing works
“Research showed that 14% of people with type 2 diabetes have anxiety disorders and that having anxiety at baseline significantly increases the risk of developing diabetes [14,15].”
BackgroundTzeng, W., Tai, Y., Feng, H., Lin, C., & Chang, Y. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12993 · Cited by 4 · see citing works
Metabolic Problems Among People With Treatment-Resistant Schizophrenia are Not Unique to Clozapine
John, A. P., Prajapati, H., & Dragović, M. (2025) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000002058 · Cited by 3 · see citing works
“30 Similarly, another meta-analysis of 120 studies, the majority from high-income countries, found that the pooled prevalence of obesity in people with SMI was 25.9%, signi fi cantly lower than 37.4% in our study.”
InfluentialEzinne, N. E., Agho, K., Doyle, A. K., Lee, M., Jung, S.-B., & Osuagwu, U. L. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02656-7 · Cited by 3 · see citing works
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Prevalence of Type 2 Diabetes among Persons with Disabilities in the South-East Asian Region
Thiagesan, R., Gopichandran, V., Subramaniam, S., Soundari, H., & Kosalram, K. B. (2022) · Current Medical Issues · doi:10.4103/cmi.cmi_27_22 · Cited by 3 · see citing works
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Psychiatric multimorbidity in heart failure
Freedland, K. E., Skala, J. A., Steinmeyer, B. C., Carney, R. M., & Rich, M. W. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112368 · Cited by 3 · see citing works
Sánchez‐Ortí, J. V., Correa‐Ghisays, P., Balanzá‐Martínez, V., Saint-Gerons, D. M., Berenguer-Pascual, E., Mateo, C. R., Víctor, V. M., Forés-Martos, J., Valenzuela, C. S. M., Selva‐Vera, G., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-62980-6 · Cited by 3 · see citing works
“SZ, BD, and MDD were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders 5th edition [DSM-5] 22 .”
MethodIdentifying depression, diabetes distress, and suicidality among adolescents with diabetes
Glick, B. A., Hong, K. M. C., & Hoffman, R. P. (2024) · Social Work in Health Care · doi:10.1080/00981389.2024.2400883 · Cited by 2 · see citing works
“Research has suggested that the metabolic impact that diabetes may have on nerve endings and blood vessels may inhibit brain functioning and potentially increase depression (Lindekilde et al., 2022; Northam, 2004).”
DeVries, C., Rodríguez-Putnam, A., Ewen, A. M., Flores, B., Choudhary, P., Spring, E., Miller, A., Zhong, C., Mannor, K., Messina, R., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-088082 · Cited by 2 · see citing works
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“The comorbidity of schizophrenia and T2DM is well documented in the literature [10–12].”
Rønne, S. T., Rothmann, M. J., Jørgensen, R., Joensen, L. E., Cleal, B. R., Gæde, P., Holt, R. I. G., & Arnfred, S. (2025) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2025.2524371 · Cited by 2 · see citing works
“People with severe mental illness, including schizophrenia, are at higher risk of developing type 2 diabetes compared to people without severe mental illness [1,2].”
Ho, M. T. H., Chan, J. K. N., Lo, H. K. Y., Fang, C. Z., Wong, C. S. M., Lee, K. C. K., & Chang, W. C. (2025) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2025.08.004 · Cited by 2 · see citing works
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Ho, M. T. H., Chan, J. K. N., Lo, H. K. Y., Fang, C. Z., Wong, C. S. M., Lee, K. C. K., Lai, F. T. T., Ng, A. P. P., Wong, W. C. W., & Chang, W. C. (2026) · Psychotherapy and Psychosomatics · doi:10.1159/000550667 · Cited by 2 · see citing works
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“Previous studies have demonstrated that psychiatric disease may increase the risk of new-onset diabetes [30, 31] and associates with prevalent diabetes [32].”
BackgroundJacob, G., Ocytil, Y., & Brenner, B. (2024) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0044-1800968 · Cited by 5 · see citing works
“45 These fi ndings emphasize the critical need for regular metabolic monitoring and proactive management of diabetes risk in psychiatric patients, especially those undergoing antipsychotic treatment.”
Rønne, S. T., Arnfred, S., Gæde, P., Cleal, B. R., & Jørgensen, R. (2025) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2025.2502932 · Cited by 2 · see citing works
“…with prescribed anti-diabetes medication increased the number of eligible patients, but it still represents a low proportion of the total in Region Zealand, where approximately 4,400 people have schizophrenia [29], and according to an umbrella review, about 10% have type 2 diabetes diagnoses [30].”
Sakic, B., Erdogan, I., Fanelli, G., Arenella, M., Mota, N. R., & Bralten, J. (2024) · medRxiv · doi:10.1101/2024.10.04.24314905 · Cited by 2 · see citing works
Great Expectations: Semaglutide as Antidiabetic Weight Management in a Psychiatric Hospital
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“In English publications, the recent umbrella review (published in 2021) summarized 3 systematic reviews to pool the prevalence of T2DM in patients with depression [ 15 ].”
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“This fosters self-management behaviors, enhancing confidence and capability to execute health actions such as personalized consultations, dietary modifications, structured physical exercise, and stress management techniques (33).”
Kølbæk, P., Rohde, C., Speed, M. S., Thomsen, H. H., & Østergaard, S. D. (2026) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.70114 · Cited by 1 · see citing works
“Previous studies have primarily examined screening practices and T2D prevalence rates [4], while there has been less emphasis on the extent of clinical intervention following detection of incident T2D in psychiatric services.”
Ho, M. T. H., Chan, J. K. N., Lo, H. P., Fang, C. Z., Wong, C. S. M., Lee, K. C. K., Lai, F. T. T., Ng, A. P. P., Wong, W. C. W., & Chang, W. C. (2026) · Psychological Medicine · doi:10.1017/s0033291726104759 · Cited by 1 · see citing works
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Antipsychotic Exposure and Pharmacologically Treated Type 2 Diabetes in Dutch Youths
Gangapersad, R. N., García‐Gómez, P., Koch, B. C. P., Moghani, V., & Dierckx, B. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.25377 · Cited by 1 · see citing works
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“Diabetes is two to three times more common among individuals with psychiatric disorders than in the general population [4], due in part to weight gain arising from the use of psychotropic drugs and unhealthy life-style behaviors and inadequate diabetes management [5].”
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“[14].”
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Pekin, C., McHale, M., & Byrne, G. J. (2022) · Global Journal of Obesity Diabetes and Metabolic Syndrome · doi:10.17352/2455-8583.000058
Halimi, S. (2022) · Médecine des Maladies Métaboliques · doi:10.1016/j.mmm.2022.09.011
Diabetes und Psyche - ein Update
de Zwaan, M. (2023) · Info Diabetologie · doi:10.1007/s15034-023-4505-6
Delirio y Diabetes tipo 2: Revisión actualizada de su asociación fisiopatológica en la persona mayor
Moreira, H. R. R., Mejía, M. F. M., & Alencastro, J. A. P. (2023) · LATAM Revista Latinoamericana de Ciencias Sociales y Humanidades · doi:10.56712/latam.v4i3.1110
Tabarés‐Seisdedos, R., Sánchez‐Ortí, J. V., Correa‐Ghisays, P., Balanzá‐Martínez, V., Saint-Gerons, D. M., Berenguer-Pascual, E., Mateo, C. R., Víctor, V., Forés-Martos, J., Valenzuela, C. S. M., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-3710093/v1
Review: de rol van psychische stoornissen bij precisiegeneeskunde voor diabetes
Kremers, S., Elders, P., Doedes, E., de Wit, M., Pouwer, F., Beulens, J., & Rutters, F. (2024) · Nederlands Tijdschrift voor Diabetologie · doi:10.1007/s12467-024-1554-y
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Wesentliche somatische Komorbiditäten psychischer Erkrankungen
Hasan, A. (2024) · Elsevier eBooks · doi:10.1016/b978-3-437-21442-4.00005-x
Kartleggingsoversikt over sammenhengen mellom diabetes type 1 og 2 og psykiske lidelser
Wilhelmsen‐Langeland, A., Handelsby, N., Skajaa, C., Erlandsen, F., Wisting, L., & Haug, J. (2024) · Tidsskrift for Norsk psykologforening · doi:10.52734/rfbg1082
Sánchez‐Ortí, J. V., Correa‐Ghisays, P., Balanzá‐Martínez, V., Selva‐Vera, G., Víctor, V. M., Valenzuela, C. S. M., Soldevila-Matías, P., Robledo-Yagüe, F., Flores-Rodero, M., Sánchez-Valle, J., et al. (2025) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2025.100962
Digital Psychiatry for the Treatment of Comorbid Disorders
Orsolini, L., Fiorani, M., Longo, G., & Volpe, U. (2025) · Springer eBooks · doi:10.1007/978-3-031-81802-8_20
Ideación suicida en adultos peruanos con riesgo de diabetes mellitus-2: un estudio analítico
Wiener, U. P. N., & Tirado, A. G. (2024) · Revista Facultad Nacional de Salud Pública · doi:10.17533/udea.rfnsp.e356362
(2025) · Elsevier eBooks · doi:10.1016/b978-3-437-21835-4.00116-5
Miller, C. K., Young-Hyman, D. L., Wooldridge, J. S., Piatt, G., & Hawkins, J. (2025) · Clinical Diabetes · doi:10.2337/cd25-0020 · Cited by 1 · see citing works
Blood Biomarkers in Bipolar Disorder
Zhao, N. O., Chiang, S., Jha, R., & Fries, G. R. (2025) · Springer eBooks · doi:10.1007/978-3-031-85519-1_14
- Authors
- Lindekilde, N., Scheuer, S. H., Rutters, F., Knudsen, L., Lasgaard, M., Rubin, K. H., Henriksen, J. E., Kivimäki, M., Andersen, G. S., & Pouwer, F.
- Affiliations
- University of Southern Denmark (DK)
- Steno Diabetes Center Copenhagen (DK)
- Amsterdam Public Health (NL)
- Central Denmark Region (DK)
- Odense University Hospital (DK)
- Deakin University (AU)
- Corresponding author
- Lindekilde, Nanna
- ORCID
- Venue
- Diabetologia
- Published
- 2021-11-29
- Volume
- 65
- Issue
- 3
- Pages
- 440-456
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W3216957364
- Cited by
- 119
- References
- 80
- Citations by year
- 2026: 27 · 2025: 31 · 2024: 28 · 2023: 19 · 2022: 14
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (acceptedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (acceptedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- NordForsk
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark
- The National Institute on Aging (R01AG062553)
- The Academy of Finland (329202)
- The UK Medical Research Council (R024227)
- Helsinki Institute of Life Science
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- type 2 diabetes, mental illness, diabetes prevalence, comorbidities, sleep disorders, binge eating disorder, substance use disorders, anxiety disorders, bipolar disorder, psychosis, schizophrenia, depression, intellectual disability, diabetes screening
- MeSH terms
- Systematic Reviews as Topic, Adolescent, Adult, Anxiety Disorders, Mental Disorders, Diabetes Mellitus, Type 2, Humans, Comorbidity, Prevalence, Observational Studies as Topic
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