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Insulin Resistance Is Associated With Hypercortisolemia in Polynesian Patients Treated With Antipsychotic Medication

Molecular Psychiatry Research Group, Christchurch School of Medicine and Health Science, University of Otago, Christchurch, New Zealand

Address correspondence and reprint requests to Nicola R. Poa, Molecular Psychiatry Research Group, Christchurch School of Medicine and Health Science, University of Otago, Christchurch, New Zealand. E-mail: nicola.poa{at}chmeds.ac.nz

OBJECTIVE—Type 2 diabetes is more prevalent in the indigenous Polynesian population of New Zealand (Maori) than in Europeans. The aim of this study was to determine whether insulin resistance in Maori psychiatric patients was associated with antipsychotic treatment and to investigate the mechanism of an association.

RESEARCH DESIGN AND METHODS—Thirty adult Maori psychiatric patients receiving antipsychotic medication for >6 months and 30 healthy, age-, sex-, and BMI-matched control subjects were enrolled. Early morning fasting blood samples were analyzed for plasma levels of glucose, insulin, A1C, triglycerides, total cholesterol, IGF-1, cortisol, cortisol-binding globulin (CBG), and adiponectin.

RESULTS—The patient group had significantly higher median fasting insulin plasma levels than the control group (P = 0.002), which were independent of BMI, age, and sex. In addition, the patient group had significantly higher total cortisol (P = 0.03) and lower CBG levels (P = 0.004) than the control group, resulting in significantly higher levels of free cortisol (P = 0.004). The patient group was also significantly more hypoglycemic (P = 0.026) and hypertriglyceridemic (P = 0.028) than the control group. There was no significant difference in BMI, waist circumference, A1C, total cholesterol, IGF-1, or adiponectin levels between the two groups.

CONCLUSIONS—An increase in insulin resistance is seen in Maori psychiatric patients treated with antipsychotic medication. Therefore, Polynesian ethnicity should be considered in prescribing practice and general care of this group. In addition, the hypothalamic-pituitary-adrenal axis may have an important role in the mechanism by which this insulin resistance develops.

Abbreviations: CBG, cortisol-binding globulin • CVD, cardiovascular disease • DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision • HOMA, homeostasis model of assessment • HOMA%S, HOMO percentage sensitivity

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