Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis

Purpose of the Review: Schizophrenia and bipolar disorder are understood to have neuroinflammatory/neuro-immunological basis in their etiopathogenesis. There are few studies synthesizing the association of schizophrenia and bipolar disorder in type 1 diabetes mellitus (T1DM), a common immunological...

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Main Authors: Sindhu Toomukuntla, Chandra Vamshi Vemula, Mamidipalli Sai Spoorthy, Syed Ahmed Zaki, Sai Krishna Tikka
Format: Article
Language:English
Published: SAGE Publishing 2025-03-01
Series:Indian Journal of Psychological Medicine
Online Access:https://doi.org/10.1177/02537176241238959
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author Sindhu Toomukuntla
Chandra Vamshi Vemula
Mamidipalli Sai Spoorthy
Syed Ahmed Zaki
Sai Krishna Tikka
author_facet Sindhu Toomukuntla
Chandra Vamshi Vemula
Mamidipalli Sai Spoorthy
Syed Ahmed Zaki
Sai Krishna Tikka
author_sort Sindhu Toomukuntla
collection DOAJ
description Purpose of the Review: Schizophrenia and bipolar disorder are understood to have neuroinflammatory/neuro-immunological basis in their etiopathogenesis. There are few studies synthesizing the association of schizophrenia and bipolar disorder in type 1 diabetes mellitus (T1DM), a common immunological disorder. Collection and Analysis of Data: We performed meta-analyses of studies assessing the prevalence and risk of schizophrenia and related disorders and bipolar disorder in individuals with T1DM. Fifteen studies consisting of a total sample of 9,768,028 (T1DM: 435,553; non-T1DM controls: 9,332,475) were included. Random-effects meta-analyses using the restricted maximum likelihood method for pooling logit transformed prevalence values and the Mantel–Haenszel test for pooling risk ratios were used. I 2 statistic and the rank correlation test for Funnel plots’ asymmetry were used to assess heterogeneity and publication bias, respectively. Results: Pooled (transformed-back-transformed) prevalence for schizophrenia and related psychotic disorders was 0.37% (95%CI: 0.19–0.73), and for bipolar disorder it was 0.39% (95%CI: 0.05–2.99) (together: 0.38% (95%CI: 0.2–0.71)] in T1DM. The prevalence models showed significant heterogeneity but were statistically significant, had low publication bias, and survived sensitivity analysis. The pooled risk ratio for schizophrenia and related disorders together with bipolar disorder was 1.80 (95%CI: 0.64–5.03), and for schizophrenia and related disorders alone it was 1.19 (95%CI: 0.46–3.11), indicating higher rates of these disorders in T1DM. The pooled risk ratios were not statistically significant and did not survive sensitivity analysis. Trial sequential analysis suggested the need for more studies to confirm increased risk. Conclusion: With available studies, we could not provide convincing evidence for the hypothesis that the prevalence and risk of schizophrenia and related disorders and bipolar disorder are significantly greater in individuals with T1DM.
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spelling doaj-art-fe9280ee9c344a838e68f13697ec14b12025-08-20T02:14:06ZengSAGE PublishingIndian Journal of Psychological Medicine0253-71760975-15642025-03-014710.1177/02537176241238959Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysisSindhu Toomukuntla0Chandra Vamshi Vemula1Mamidipalli Sai Spoorthy2Syed Ahmed Zaki3Sai Krishna Tikka4 Medical Undergraduate Student Division, All India Institute of Medical Sciences Bibinagar, Hyderabad, Telangana, India. Medical Undergraduate Student Division, All India Institute of Medical Sciences Bibinagar, Hyderabad, Telangana, India. Dept. of Psychiatry, All India Institute of Medical Sciences Bibinagar, Hyderabad, Telangana, India Dept. of Pediatrics, All India Institute of Medical Sciences Bibinagar, Hyderabad, Telangana, India. Dept. of Psychiatry, All India Institute of Medical Sciences Bibinagar, Hyderabad, Telangana, IndiaPurpose of the Review: Schizophrenia and bipolar disorder are understood to have neuroinflammatory/neuro-immunological basis in their etiopathogenesis. There are few studies synthesizing the association of schizophrenia and bipolar disorder in type 1 diabetes mellitus (T1DM), a common immunological disorder. Collection and Analysis of Data: We performed meta-analyses of studies assessing the prevalence and risk of schizophrenia and related disorders and bipolar disorder in individuals with T1DM. Fifteen studies consisting of a total sample of 9,768,028 (T1DM: 435,553; non-T1DM controls: 9,332,475) were included. Random-effects meta-analyses using the restricted maximum likelihood method for pooling logit transformed prevalence values and the Mantel–Haenszel test for pooling risk ratios were used. I 2 statistic and the rank correlation test for Funnel plots’ asymmetry were used to assess heterogeneity and publication bias, respectively. Results: Pooled (transformed-back-transformed) prevalence for schizophrenia and related psychotic disorders was 0.37% (95%CI: 0.19–0.73), and for bipolar disorder it was 0.39% (95%CI: 0.05–2.99) (together: 0.38% (95%CI: 0.2–0.71)] in T1DM. The prevalence models showed significant heterogeneity but were statistically significant, had low publication bias, and survived sensitivity analysis. The pooled risk ratio for schizophrenia and related disorders together with bipolar disorder was 1.80 (95%CI: 0.64–5.03), and for schizophrenia and related disorders alone it was 1.19 (95%CI: 0.46–3.11), indicating higher rates of these disorders in T1DM. The pooled risk ratios were not statistically significant and did not survive sensitivity analysis. Trial sequential analysis suggested the need for more studies to confirm increased risk. Conclusion: With available studies, we could not provide convincing evidence for the hypothesis that the prevalence and risk of schizophrenia and related disorders and bipolar disorder are significantly greater in individuals with T1DM.https://doi.org/10.1177/02537176241238959
spellingShingle Sindhu Toomukuntla
Chandra Vamshi Vemula
Mamidipalli Sai Spoorthy
Syed Ahmed Zaki
Sai Krishna Tikka
Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis
Indian Journal of Psychological Medicine
title Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis
title_full Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis
title_fullStr Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis
title_full_unstemmed Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis
title_short Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis
title_sort prevalence and risk of schizophrenia and bipolar disorder in patients with type 1 diabetes mellitus a systematic review and meta analysis
url https://doi.org/10.1177/02537176241238959
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