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

Immunosenescence and CoQ10

The decline of the immune system associated to aging is becoming a global issue nowadays due to the increase of lifespan. Immunosenescence is the deteriorated adaptative capacity of the immune system leading to increase in morbidity and mortality in elderly population. Aging has been related to a progressive affectation of mitochondria such as increase of mtDNA mutation, deregulation of electron transport chain, increase in ROS production and reduction in ATP production. Immunosenescence has been associated with aging associated mitochondrial dysfunction linked to chronic inflammation that induce higher oxidative stress levels and mitochondrial damage deteriorating the already compromised immune system. CoQ10 administration could be considered a beneficial strategy in order to reduce the progression of age-related diseases. Highlighting the important role of CoQ10 on mitochondrial function it has been proposed that this unique antioxidant soluble lipid could be helpful in the management of immunosenescence. High levels of CoQ10 have been related with a delay of immunosenescence attributable to a reduction in DNA damage. Other prolongevity factors, such as caloric restriction and exercise, have been considered for their potential effect in delaying aging effect and immunosenescence mainly affecting mitochondrial physiology and biogenesis and antioxidant activity