Type 1 diabetes

Preventing diabetes in people with schizophrenia

Wednesday, 23 May 2018



Can you describe the aim of this project in 10 words?

Determining if metformin prevents weight gain in patients commencing clozapine

What do we already know about diabetes and CVD risk in people with schizophrenia?

Schizophrenia can shorten the life expectancy of a person by up to 16 years, with 35.1% of excess deaths attributable to cardiovascular disease and type 2 diabetes. Clozapine is used for treatment refractory schizophrenia and a US study has shown after 10 years of treatment, 43% developed type 2 diabetes with a mean weight gain of over 13.5kg.

What have you discovered in this area so far?

We recently published a meta-analysis showing metformin can lead to a greater than 3kg weight loss among people already obese on clozapine. There have not been any studies looking at metformin on commencement of clozapine. We have also performed a pilot study demonstrating once-weekly exenatide can lead to weight loss of 5.29kg versus 1.12kg in patients on clozapine.

What aspect of this research excites you the most?

Collaborating with a great psychiatrist and using our common research interests to actually make some changes in the way we manage this population of patients.

How long before this project might impact patient care?

The study duration is 24 weeks. It will be 12 months until we get some results which we hope will be favorable and guide the design of a study for broader translation.

Are specific target groups, like these psychiatric patients, an area of unmet need and where real gains can be made?

The Australian Diabetes Society has recently issued a position statement on the prevention and management of type 2 diabetes in the context of psychotic disorders. This document emphasizes the importance of addressing this huge area of unmet need around the metabolic consequences of schizophrenia and the anti-psychotic agents. Patients with schizophrenia are often difficult to engage in life-style interventions and may not attend routine appointments to their GP or diabetes clinic. As endocrinologists, we need to work closely with our psychiatry colleagues, and any safe drug therapy that might assist in reducing this gap in survival in patients with schizophrenia would be a huge gain.

What’s your Holy Grail – the one thing you’d like to achieve in your research career?

Translation of a research outcome that touches the life of many people who live with diabetes.

What is your biggest research hurdle?

Not enough hours in the day.

Who has inspired you in work or life?

Professor John Prins has been my work mentor – a true clinician scientist who leads by example and makes others feel good about themselves.

Describe your perfect day.

A lazy Sunday with the family; sleep in, brunch, tennis and a movie.

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