The relationship between bipolar disorder and type 2 diabetes: More than just co-morbid disorders

Figures & data

Table I. Type 2 diabetes risk reduction and management in patients with bipolar disorder.

Prevention:

Diet low in simple carbohydrates

Regular aerobic exercise

Address sleep disturbance if present

Screening/surveillance:

Fasting plasma glucose (FPG) every 2–3 years, regardless of bipolar treatment

FPG at 3 and 6 months, then every 6 months if on chlorpromazine, clozapine, or olanzapine

FPG at 6 and 12 months, then every 12 months if on other antipsychotic

Management of medication-induced weight gain or type 2 diabetes:

Diet and exercise (see Prevention)

Consider switching antipsychotic to another mood stabilizer, if possible

If unable to switch, consider adding metformin

Treatment of type 2 diabetes in patients with bipolar disorder:

Non-pharmacologic

Diet and exercise (see Prevention)

Weight and glycemic control

Decrease cardiovascular risk factors

Ensure vaccinations are up to date

Pharmacologic

Consider metformin as first-line treatment if non-pharmacologic measures ineffective

Consider glucagon-like peptidase-1 receptor agonists/analogues or dipeptidyl peptidase-4 inhibitors

Consider other oral antihyperglycemics

Consider insulin, if oral antihyperglycemics not effective