Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Risky business: Screening and acting on metabolic disease in patients attending a clozapine outpatient service in the ‘Diabetes Hotspot’ of Sydney’s West (#234)

Ramy H Bishay 1 2 3 , Manimegalai Manoharan 1 2 , Yolinda Assur 4 , Tristen Nguyen 1 , Sian Bramwell 1 , Rajini Jayaballa 1 , Glen F Maberly 1 2 3 , Ramy Bishay 1 2 3
  1. Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, NSW, Australia
  2. School of Medicine, University of Western Sydney, Sydney, NSW, Australia
  3. School of Medicine, University of Sydney, Sydney, NSW, Australia
  4. Department of Psychiatry, Blacktown Hospital, Sydney, NSW, Australia

INTRODUCTION A reduced life expectancy of 20-30 years and a two-to-four times risk of metabolic morbidity in individuals treated with second-generation anti-psychotics (SGA) is well known. Little has been described in mental health patients on SGAs in Sydney’s west, which possesses one of the highest rates of obesity and type 2 diabetes (T2D) in the country. METHODS Clinical and biochemical data was collected at baseline and at follow-up over a 3 year period in patients attending an outpatient clozapine clinic for the management of psychosis. Patients with T2D were seen by the diabetes community team (medical, diabetes educator) over 1-2 visits and discharged to the community general practitioner. RESULTS Approximately, 187 patients were screened and 105 were followed-up (mean 2.01+/-1.03 years). Mean BMI was in the obese category I (T2D, 33.6+/-6.3, non-T2D, 31.3+/-7.4 kg/m2). There was a disproportionate diagnoses of T2D in this cohort (n=51, 27.7% vs 136 non-T2D) with a mean HbA1c of 7.9+/-2.3% and an equal gender distribution (51.9% male, vs 63.1% in non-T2D group). Compared to non-T2D, T2D patients tended to be older (45.6+/-10.4 vs 37.9+/-10.4 years) and had a longer duration of clozapine use (median 6.8 vs 5.3 years, non-significant difference). Interestingly, at follow-up, significant weight gain was observed in the non-T2D (+2.26+/-5.8 kg, p=0.01) whereas T2D individuals trended towards weight loss (-2.81+/-8.7 kg, p=0.09), had non-significant reductions in HbA1c (-0.51+/-2.2%, p=0.39), blood pressure and improved lipid profile. Two patients converted to T2D though likely underestimated due to loss of follow-up. CONCLUSION Patients with T2D on SGAs are able to alter their disease trajectory by engaging with the diabetes specialist team and amelioration of cardiometabolic risk factors. In contrast, patients without T2D may be a neglected population, necessitating vigilant surveillance of metabolic dysfunction in all patients treated with SGAs.