HbA1c moves in the first 90 days of an antipsychotic, and GLP-1 agonists are linked to fewer psychiatric admissions

The edition in brief

In 96,849 adults with severe mental illness in England, HbA1c rose about twelve times faster and weight about ten times faster in the 90 days after starting an oral second-generation antipsychotic than before, then slowed; olanzapine showed the steepest rises, and 19% of people with prediabetes at baseline developed type 2 diabetes within two years. The authors support checking both HbA1c and weight at baseline and at 12 weeks. A US cohort of 70,257 adults with schizophrenia and type 2 diabetes found GLP-1 receptor agonist initiation was associated with fewer psychiatric hospitalisations than non-initiation (HR 0.76) and than DPP-4 or SGLT2 inhibitors, an observational signal only. A Norwegian registry of 321,708 people found each compulsory care group carried a distinct long-term prognosis, with the compulsory observation group showing the highest probability of self-harm or suicide. A meta-analysis of seven trials suggested high-frequency rTMS may improve sleep and mood in depression with insomnia, on low-certainty evidence. The pearl covers ordering the 12-week metabolic check at the first prescription.