Diabetes Complications, Attempted Suicide Risk in Comorbid T1D and Schizophrenia

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This comorbidity occurs in <1% of the population of young patients hospitalized with type 1 diabetes, but it is a significant factor in morbidity and mortality.
This comorbidity occurs in <1% of the population of young patients hospitalized with type 1 diabetes, but it is a significant factor in morbidity and mortality.

Patients with type 1 diabetes and schizophrenia face a higher risk for hospitalization for acute diabetes complications, as well as for suicide attempts and in-hospital mortality, according to findings published in Diabetes Care.

A number of studies have confirmed an increased risk for type 2 diabetes in individuals with schizophrenia, but the association between type 1 diabetes and schizophrenia remains uncertain. In this study, researchers hypothesized that hospitalized individuals with type 1 diabetes and schizophrenia would have a higher incidence of rehospitalization for acute diabetes complications or suicide attempts, as well as a greater risk for mortality, as compared with patients with diabetes, but without comorbid schizophrenia.

A retrospective nationwide population-based study was conducted including 45,655 individuals aged 15 to 35 years who were hospitalized for type 1 diabetes from 2009 to 2012. Of this cohort, 341 (0.75%) had been hospitalized for schizophrenia. Within 3 years of follow-up, a history of schizophrenia was associated with a higher risk of being rehospitalized for complications related to diabetes, including hypoglycemia (adjusted odds ratio [aOR], 3.21; 95% CI, 1.99-5.20), hyperglycemia (aOR, 7.01; 95% CI, 3.53-13.90), ketoacidosis (aOR, 2.01; 95% CI, 1.49-2.70), and coma (aOR, 3.17; 95% CI, 1.90-5.27). 

Patients' risk for hospitalization for suicide attempts (aOR, 12.15; 95% CI, 8.49-17.38) and hospital mortality (aOR, 2.83; 95% CI, 1.50-5.36) were also higher. In addition, being hospitalized for attempted suicide was associated with a higher risk for hospitalization for acute diabetes complications, independent from schizophrenia (adjusted hazard ratio, 3.46; 95% CI, 2.74-4.38).

"Overall, diabetes complications and suicide attempts may be markers of more severe physio- and psychopathology in a subset of patients, notably, but not only, in those with schizophrenia," noted the researchers. "This excessively fragile subgroup of patients may require specific care programs combining the joint action of teams specialized in diabetes and schizophrenia and close monitoring of mental, somatic, and social health."

Reference

Goueslard K, Petit JM, Cottenet J, Chauvet-Gelinier JC, Jollant F, Quantin C. Increased risk of rehospitalization for acute diabetes complications and suicide attempts in patients with type 1 diabetes and comorbid schizophrenia [published online August 27, 2018]. Diabetes Care. doi:10.2337/dc18-0657

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