The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration’s tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI

Lebensqualität für Menschen mit bipolaren Störungen : Effekte einer multimodalen Gewichtsmanagement-Intervention : das LQ-bip-Programm

Background: Patients with bipolar disorder are reliant on maintenance pharmacotherapy which enhances the risk of weight gain. Possible consequences are the development of a metabolic syndrome, diabetes mellitus type II, cardiovascular or further diseases or a reduced compliance with enhanced risk of relapses (into bipolar symptoms). The study applies a prospective, randomized controlled design that contrasts a multimodal lifestyle intervention for reduction of weight in patients with bipolar disorder with the standard treatment. Method: There were 50 patients with bipolar disorder who were pharmacologically treated, after randomization n=26 attended the program “Quality of Life for Persons with Bipolar Disorder” during 5 months. Body weight, Body Mass Index (BMI), metabolic changes and physical activity were determined as baseline after 5 and 11 months. Results The BMI of the intervention group was significantly reduced during the course of the intervention about 0.3 kg/m2 (95% CI -0.7-0.06). In the control group the BMI increased about 0.5 kg/m2 (95% CI 0.01- 0.8). The mean difference in change scores differed significantly between the groups being stable after 5 and 11 months. This effect relates only to female participants. Concerning self reported physical activity there was a significant interaction effect (time x interaction) between intervention and control group (F (2/47) =3.19, p=0.05). Conclusion: With the presented multimodal program of lifestyle intervention for patients with bipolar disorder a significant reduction in BMI can be achieved which remains stable over six month follow up. Hintergrund Patienten mit bipolaren Störungen sind auf eine Phasenprophylaxe mit Psychopharmaka angewiesen, welche das Risiko einer Gewichtszunahme bergen. Die Entwicklung eines metabolischen Syndroms, eines Diabetes mellitus Typ II, kardiovaskuläre und andere schwerer Erkrankungen können die Folge sein, aber auch eine herabgesetzte Compliance mit einem erhöhten Rückfallrisiko in die bipolare Symptomatik. Die vorliegende Arbeit stellt die randomisiert-kontrollierte Evaluation eines multimodalen Interventionsprogramms zur Beeinflussung des Gewichts bei pharmakologisch behandelten bipolaren Patienten vor. Methode 50 pharmakologisch behandelte Patienten mit bipolaren Störungen wurden randomisiert und nahmen über 5 Monate an dem Programm «Lebensqualität für Menschen mit bipolaren Störungen» (LQ-bip- Programm, n=26) oder einer Kontrollgruppe (n=24) teil. Gewicht, Body Mass Index (BMI), metabolische Veränderungen und die körperliche Aktivität wurden als Baseline, nach 5 und 11 Monaten bestimmt. Ergebnisse 47 (94 %) Patienten nahmen bis zum Ende der Studie teil. In der Interventionsgruppe zeigte der BMI eine signifikante Abnahme über die Zeit von 0.3 kg/m2 (95 % CI −0.7–0.06), in der Kontrollgruppe einen Zuwachs von 0.5 kg/m2 (95 % CI 0.01–0.8), die mittleren Differenzen der Veränderungswerte unterschieden sich signifikant zwischen den Gruppen, mit anhaltenden BMI-Unterschieden nach 5 und 11 Monaten. Der Effekt fand sich nur bei den Frauen. Bezüglich der selbstberichteten körperlichen Aktivität zeigte sich ein signifikanter Interaktionseffekt (Zeit × Interaktion) zwischen der Interventions- und Kontrollgruppe (F (2/47)=3.19, p=0.05). Folgerung Mit der vorgestellter multimodalen Lifestyle-Intervention für Patienten mit bipolaren Störungen lässt sich eine signifikante Reduktion des BMIs erreichen, welche über 6 Monate Follow up erhalten bleibt

Die Errichtung des staendigen Internationalen Gerichtshofes Beginn einer neuen Aera?

Die Verabschiedung des Statuts zur Errichtung eines Staendigen Internationalen Strafgerichtshofes (International Criminal Court, ICC) im Juli 1998 in Rom hat eine neue Aera in der internationalen Strafgerichtsbarkeit eingeleitet. Wenn auch seit laengerem Globalisierungstendenzen auf eine verminderte Regelungs- und Regierungsfaehigkeit von Staaten hinweisen und eine erhoehte Bereitschaft der Staaten erkennbar ist, Teile ihrer Souveraenitaet an internationale Organisationen abzugeben, so ist doch mit der Strafgerichtsbarkeit ein Kerngebiet staatlicher Souveraenitaet erreicht, das mit dem Statut von Rom an eine internationale Institution ueberwiesen wird. Der Gerichtshof besteht noch nicht, doch laesst sich anhand massgeblicher Artikel des Statuts ermessen, inwieweit Staaten tatsaechlich zur Abgabe nationaler Kompetenzen bereit sind. Im Ergebnis zeigt sich ein Wechselspiel zwischen staatlichen Kompetenzen und tatsaechlicher Unabhaengigkeit des Gerichtshofes, so dass mit dem ICC ein Instrument der Global Governance im Sinne einer Mehrebenenpolitik entstehen koennte. (HH)'The adoption of the Statute to establish an International Criminal Court (ICC) in Rome in July 1998 introduced a new ere in the field of international criminal jurisdiction. The globalization marks a tendency of a reduced competence of States to regulate and govern and States seem willing to hand over parts of their sovereignty to international institutions. Still, criminal jurisdiction marks the core of sovereignty that will be given to an international institution according to the Statute of Rome. The Court does not yet exist, but the competent articles of the Statute allow to draw a first conclusion to what extent the States are ready to give up parts of their national sovereignty. The result seems to be an interplay of competences on the national level and those of the ICC which indicate its independence. Hence, a new instrument of Global Governance in the sense of 'policy-making-on-several-levels' in the international field seems to be born.' (author's abstract)Available from UuStB Koeln(38)-20001102864 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Effects of a Multimodal Lifestyle Intervention on Body Mass Index in Patients With Bipolar Disorder: A Randomized Controlled Trial

Patients with bipolar disorder are at increased risk of weight gain, which in turn increases the risk for somatic disease and nonadherence to maintenance therapy. Therefore, interventions addressing weight gain are expedient for the management of this disorder. We set out to evaluate the effects of a lifestyle intervention on body mass index (BMI) and cardiovascular and metabolic parameters in patients with bipolar disorder undergoing mood-stabilizing pharmacologic treatment.; Fifty outpatients with bipolar disorder undergoing mood-stabilizing treatment participated in a randomized controlled trial (waiting control group: n = 24 and multimodal lifestyle intervention group: n = 26). Groups consisted of 2 cohorts (cohort 1: March 2005-February 2006; cohort 2: September 2005-August 2006). The intervention lasted 5 months and consisted of 11 group sessions and weekly fitness training. BMI and body weight as well as cardiovascular and metabolic parameters were determined at 3 assessment points: at pretreatment baseline, at 5 months (end of treatment), and at 11 months (6-month follow-up).; Intention-to-treat analyses showed that the intervention significantly reduced BMI over time (P = .03), with significant and stable mean differences in BMI change between groups of 0.7 kg/m² (95% CI, 0.2-1.3) at 5 months and 0.8 kg/m² (95% CI, 0.1-1.6) at 11 months' follow-up assessment. The lifestyle intervention had no significant effect on cardiovascular and metabolic parameters (all nonsignificant). The BMI reduction was only seen in female patients (P = .003).; BMI in patients with bipolar disorder can be reduced with a long-lasting effect by a multimodal lifestyle intervention. However, this effect was only seen in female participants, indicating the need for gender-specific interventions.; clinicaltrials.gov Identifier: NCT00980863