The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis
People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions...
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| Veröffentlicht in: | PloS one 2017-01, Vol.12 (1), p.e0168549-e0168549 |
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| creator | Taylor, Johanna Stubbs, Brendon Hewitt, Catherine Ajjan, Ramzi A Alderson, Sarah L Gilbody, Simon Holt, Richard I G Hosali, Prakash Hughes, Tom Kayalackakom, Tarron Kellar, Ian Lewis, Helen Mahmoodi, Neda McDermid, Kirstine Smith, Robert D Wright, Judy M Siddiqi, Najma |
| description | People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration's tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p |
| doi_str_mv | 10.1371/journal.pone.0168549 |
| format | Article |
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We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration's tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0168549</identifier><identifier>PMID: 28056018</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Adults ; Antipsychotics ; Biology and Life Sciences ; Blood Glucose - drug effects ; Care and treatment ; Clinical trials ; Comparative analysis ; Confidence intervals ; Data processing ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - blood ; Diabetes Mellitus - drug therapy ; Drug therapy ; Fasting ; Fasting - blood ; Food and nutrition ; Glucose ; Glycated Hemoglobin A - metabolism ; Health risks ; Health sciences ; Hemoglobin ; Heterogeneity ; Humans ; Insulin ; Intervention (Psychology) ; Laboratory testing ; Life expectancy ; Life span ; Medicine and Health Sciences ; Mental disorders ; Mental Disorders - blood ; Mental Disorders - drug therapy ; Mentally ill persons ; Meta-analysis ; Metabolic diseases ; Metabolism ; Metformin ; Metformin - therapeutic use ; Pharmacology ; Physical activity ; Physiological aspects ; Population ; Psychiatry ; Psychosis ; Psychotropic drugs ; Regression analysis ; Schizophrenia ; Statistical analysis ; Studies ; Switching ; Systematic review</subject><ispartof>PloS one, 2017-01, Vol.12 (1), p.e0168549-e0168549</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Taylor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Taylor et al 2017 Taylor et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c776t-a6785f13062be276282797211a4bf58f94812461afdeecb8ab952b4d49609b953</citedby><cites>FETCH-LOGICAL-c776t-a6785f13062be276282797211a4bf58f94812461afdeecb8ab952b4d49609b953</cites><orcidid>0000-0002-7165-5878 ; 0000-0002-8692-126X ; 0000-0002-4062-2539 ; 0000-0002-5418-0495 ; 0000-0002-2237-1369</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215855/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215855/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23847,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28056018$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Wu, Wen-Chih Hank</contributor><creatorcontrib>Taylor, Johanna</creatorcontrib><creatorcontrib>Stubbs, Brendon</creatorcontrib><creatorcontrib>Hewitt, Catherine</creatorcontrib><creatorcontrib>Ajjan, Ramzi A</creatorcontrib><creatorcontrib>Alderson, Sarah L</creatorcontrib><creatorcontrib>Gilbody, Simon</creatorcontrib><creatorcontrib>Holt, Richard I G</creatorcontrib><creatorcontrib>Hosali, Prakash</creatorcontrib><creatorcontrib>Hughes, Tom</creatorcontrib><creatorcontrib>Kayalackakom, Tarron</creatorcontrib><creatorcontrib>Kellar, Ian</creatorcontrib><creatorcontrib>Lewis, Helen</creatorcontrib><creatorcontrib>Mahmoodi, Neda</creatorcontrib><creatorcontrib>McDermid, Kirstine</creatorcontrib><creatorcontrib>Smith, Robert D</creatorcontrib><creatorcontrib>Wright, Judy M</creatorcontrib><creatorcontrib>Siddiqi, Najma</creatorcontrib><title>The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration's tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.</description><subject>Adult</subject><subject>Adults</subject><subject>Antipsychotics</subject><subject>Biology and Life Sciences</subject><subject>Blood Glucose - drug effects</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Comparative analysis</subject><subject>Confidence intervals</subject><subject>Data processing</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - blood</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Drug therapy</subject><subject>Fasting</subject><subject>Fasting - blood</subject><subject>Food and nutrition</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Health risks</subject><subject>Health sciences</subject><subject>Hemoglobin</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Insulin</subject><subject>Intervention (Psychology)</subject><subject>Laboratory testing</subject><subject>Life expectancy</subject><subject>Life span</subject><subject>Medicine and Health Sciences</subject><subject>Mental disorders</subject><subject>Mental Disorders - blood</subject><subject>Mental Disorders - drug therapy</subject><subject>Mentally ill persons</subject><subject>Meta-analysis</subject><subject>Metabolic diseases</subject><subject>Metabolism</subject><subject>Metformin</subject><subject>Metformin - therapeutic use</subject><subject>Pharmacology</subject><subject>Physical activity</subject><subject>Physiological aspects</subject><subject>Population</subject><subject>Psychiatry</subject><subject>Psychosis</subject><subject>Psychotropic drugs</subject><subject>Regression analysis</subject><subject>Schizophrenia</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Switching</subject><subject>Systematic 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Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis</title><author>Taylor, Johanna ; Stubbs, Brendon ; Hewitt, Catherine ; Ajjan, Ramzi A ; Alderson, Sarah L ; Gilbody, Simon ; Holt, Richard I G ; Hosali, Prakash ; Hughes, Tom ; Kayalackakom, Tarron ; Kellar, Ian ; Lewis, Helen ; Mahmoodi, Neda ; McDermid, Kirstine ; Smith, Robert D ; Wright, Judy M ; Siddiqi, Najma</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c776t-a6785f13062be276282797211a4bf58f94812461afdeecb8ab952b4d49609b953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Antipsychotics</topic><topic>Biology and Life Sciences</topic><topic>Blood Glucose - drug effects</topic><topic>Care and treatment</topic><topic>Clinical 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Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Taylor, Johanna</au><au>Stubbs, Brendon</au><au>Hewitt, Catherine</au><au>Ajjan, Ramzi A</au><au>Alderson, Sarah L</au><au>Gilbody, Simon</au><au>Holt, Richard I G</au><au>Hosali, Prakash</au><au>Hughes, Tom</au><au>Kayalackakom, Tarron</au><au>Kellar, Ian</au><au>Lewis, Helen</au><au>Mahmoodi, Neda</au><au>McDermid, Kirstine</au><au>Smith, Robert D</au><au>Wright, Judy M</au><au>Siddiqi, Najma</au><au>Wu, Wen-Chih Hank</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-01-05</date><risdate>2017</risdate><volume>12</volume><issue>1</issue><spage>e0168549</spage><epage>e0168549</epage><pages>e0168549-e0168549</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration's tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28056018</pmid><doi>10.1371/journal.pone.0168549</doi><tpages>e0168549</tpages><orcidid>https://orcid.org/0000-0002-7165-5878</orcidid><orcidid>https://orcid.org/0000-0002-8692-126X</orcidid><orcidid>https://orcid.org/0000-0002-4062-2539</orcidid><orcidid>https://orcid.org/0000-0002-5418-0495</orcidid><orcidid>https://orcid.org/0000-0002-2237-1369</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2017-01, Vol.12 (1), p.e0168549-e0168549 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1855782111 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adult Adults Antipsychotics Biology and Life Sciences Blood Glucose - drug effects Care and treatment Clinical trials Comparative analysis Confidence intervals Data processing Diabetes Diabetes mellitus Diabetes Mellitus - blood Diabetes Mellitus - drug therapy Drug therapy Fasting Fasting - blood Food and nutrition Glucose Glycated Hemoglobin A - metabolism Health risks Health sciences Hemoglobin Heterogeneity Humans Insulin Intervention (Psychology) Laboratory testing Life expectancy Life span Medicine and Health Sciences Mental disorders Mental Disorders - blood Mental Disorders - drug therapy Mentally ill persons Meta-analysis Metabolic diseases Metabolism Metformin Metformin - therapeutic use Pharmacology Physical activity Physiological aspects Population Psychiatry Psychosis Psychotropic drugs Regression analysis Schizophrenia Statistical analysis Studies Switching Systematic review |
| title | The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis |
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