Association between bipolar disorder and diabetic ketoacidosis/hyperosmolar hyperglycemic state.

IF 3.9 2区综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES

Scientific Reports Pub Date : 2025-07-02 DOI:10.1038/s41598-025-08087-y

Han-Jung Liu, Shih-Chang Lo, Chien-Ning Huang, Yi-Sun Yang, Yu-Hsun Wang, Edy Kornelius

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Abstract

Individuals with bipolar disorder have a higher prevalence of type 2 diabetes mellitus (T2DM) and are at increased risk for diabetes-related complications. However, little is known about the association between bipolar disorder and acute hyperglycemic crises, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). This study aimed to evaluate whether bipolar disorder is associated with an increased risk of DKA and HHS in individuals with newly diagnosed T2DM. We conducted a retrospective cohort study using the TriNetX electronic health records network. Adults diagnosed with T2DM between 2016 and 2024 who received at least one glucose-lowering medication were included. Patients with a recorded diagnosis of bipolar disorder within one year before T2DM onset formed the exposure group, while those without bipolar disorder served as controls. Individuals with pre-existing hyperglycemic crises were excluded. Propensity score matching (1:1) was applied to balance demographic factors, body mass index, comorbidities, and medication use. The primary outcome was the incidence of DKA or HHS, analyzed using Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). After matching (N = 39,676 per group), patients with bipolar disorder had a significantly higher risk of hyperglycemic crises (HR 1.65, 95% CI 1.45-1.88). Separate analyses revealed an increased risk of DKA (HR 1.58, 95% CI 1.37-1.82) and HHS (HR 1.95, 95% CI 1.30-2.94). Subgroup analyses suggested that the association was more pronounced in younger patients, White individuals, those with cerebrovascular disease, and those on insulin therapy. Bipolar disorder may be associated with a higher risk of acute hyperglycemic crises in patients with newly diagnosed T2DM. These findings highlight the need for integrated psychiatric and diabetes care to mitigate metabolic decompensation. Future prospective studies are warranted to further explore the mechanisms underlying this association and to develop targeted interventions.

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双相情感障碍与糖尿病酮症酸中毒/高渗性高血糖状态的关系。

双相情感障碍患者有较高的2型糖尿病（T2DM）患病率，并且患糖尿病相关并发症的风险增加。然而，人们对双相情感障碍与急性高血糖危象（包括糖尿病酮症酸中毒（DKA）和高渗性高血糖状态（HHS））之间的关系知之甚少。本研究旨在评估双相情感障碍是否与新诊断的T2DM患者DKA和HHS风险增加相关。我们使用TriNetX电子健康记录网络进行了一项回顾性队列研究。2016年至2024年间诊断为2型糖尿病的成年人接受了至少一种降糖药物治疗。在2型糖尿病发病前一年内有双相情感障碍诊断记录的患者组成暴露组，而没有双相情感障碍的患者作为对照。已存在高血糖危机的个体被排除在外。采用倾向评分匹配（1:1）来平衡人口统计学因素、体重指数、合并症和药物使用。主要结局是DKA或HHS的发生率，使用Cox比例风险模型进行分析，以95%置信区间（ci）估计风险比（hr）。配对后（每组N = 39,676），双相情感障碍患者发生高血糖危机的风险明显更高（HR 1.65, 95% CI 1.45-1.88）。单独的分析显示DKA（风险比1.58,95% CI 1.37-1.82）和HHS（风险比1.95,95% CI 1.30-2.94）的风险增加。亚组分析表明，这种关联在年轻患者、白人、脑血管疾病患者和接受胰岛素治疗的患者中更为明显。双相情感障碍可能与新诊断T2DM患者急性高血糖危象的高风险相关。这些发现强调需要综合精神病学和糖尿病护理来减轻代谢失代偿。未来的前瞻性研究有必要进一步探索这种关联的机制，并制定有针对性的干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Scientific Reports Natural Science Disciplines-

CiteScore

7.50

自引率

4.30%

发文量

19567

审稿时长

3.9 months

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