Variability of glucose, insulin, and lipid disturbances in first-episode psychosis: a meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational case-control studies
PubMed 37449481 · doi:10.1017/S0033291721005213
What was done
A meta-analysis of variance using the coefficient of variation ratio (CVR) and standardized mean differences was conducted across 28 studies comparing antipsychotic-naïve first-episode psychosis (FEP) patients (n = 1,716) with controls (n = 1,893). Assessed markers included fasting glucose, post-oral glucose tolerance test (OGTT) glucose, fasting insulin, insulin resistance, HbA1c, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides. Meta-regression evaluated demographic, physiological, and psychopathological moderators.
What was found
Variability was significantly higher in patients than controls for fasting glucose (CVR = 1.32; 95% CI 1.12–1.55; p = 0.001), post-OGTT glucose (CVR = 1.43; 95% CI 1.10–1.87; p = 0.008), fasting insulin (CVR = 1.31; 95% CI 1.09–1.58; p = 0.01), insulin resistance (CVR = 1.34; 95% CI 1.12–1.60; p = 0.001), HbA1c (CVR = 1.18; 95% CI 1.06–1.27; p < 0.0001), total cholesterol (CVR = 1.15; 95% CI 1.01–1.31; p = 0.03), LDL-cholesterol (CVR = 1.28; 95% CI 1.09–1.50; p = 0.002), and HDL-cholesterol (CVR = 1.15; 95% CI 1.00–1.31; p < 0.05), but not triglycerides. Mean glucose, post-OGTT glucose, fasting insulin, insulin resistance, and triglycerides were higher in patients, while mean total cholesterol and HDL-cholesterol were lower. Increased symptom severity and female sex were associated with worse metabolic profiles.
Why it matters
These findings suggest that metabolic disturbances prior to antipsychotic treatment are not uniform across all patients with psychosis, indicating the presence of high-risk subgroups that require targeted metabolic screening and early intervention.
Limits
The abstract does not provide numerical effect sizes for mean differences or meta-regression slopes. The analysis is limited by the observational and cross-sectional nature of the included primary studies, and potential residual confounders such as diet, smoking, and physical activity are not reported.
Cited by
- context Cerebral glucose hypometabolism is a central characteristic of neurodegenerative conditions and is present in schizophrenia and bipolar disorder before the diagnosis of psychosis or administration of medications.