Summary of findings 1. Atypical compared with typical antipsychotic medications for preventing type 2 diabetes in adults with mental disorders in low‐ and middle‐income countries.
| Atypical compared with typical antipsychotic medications for preventing type 2 diabetes in adults with mental disorders in low‐ and middle‐income countries | ||||||
| Patient or population: Adults with mental disorders in low‐ and middle‐income countries Setting: Hospitals in China, India and South Africa Intervention: Atypical antipsychotic medication Comparison: Typical antipsychotic medication | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with typical antipsychotic | Risk with atypical antipsychotic | |||||
| Diabetes (ADA criteria) (6 weeks) | Study population | RR 0.50 (0.03 to 7.73) | 93 (1 RCT) | ⊕⊕⊝⊝ LOW 1 | ||
| 32 per 1,000 | 16 per 1,000 (1 to 249) | |||||
| Drop‐outs (6 to 54 weeks) | Study population | RR 1.31 (0.63 to 2.69) | 144 (2 RCTs) | ⊕⊕⊝⊝ LOW 2 3 | ||
| 148 per 1,000 | 194 per 1,000 (93 to 399) | |||||
| Fasting blood glucose (6 to 8 weeks) | Mean fasting blood glucose was 4.90 to 4.91 mmol/L (normal level) | MD 0.05 lower (0.10 lower to 0.00 lower) | ‐ | 211 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 4 | |
| BMI (8 to 54 weeks) | Mean BMI was 21.2 to 24.6 kg/m2 (healthy weight range) | MD 0.57 higher (0.33 higher to 0.81 higher) | ‐ | 141 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 5 | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ADA: American Diabetes Association; BMI: Body mass index; CI: Confidence interval; MD: mean difference; RCT: randomized controlled trial; RR: Risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1One small trial; estimate with wide confidence interval crossing 1. Downgraded two levels for imprecision. 2One trial with all domains at unclear or high risk of bias, including potential conflict of interest. Downgraded one level for risk of bias. 3Two trials with confidence interval crossing 1. Downgraded one level for imprecision. 4For one trial, there were problems with randomization and for the other there was no blinding of participants or investigators. Although blood glucose is an objectively measured outcome, results may still have been influenced by knowledge of the intervention allocation. Downgraded one level for risk of bias. 5One trial with all domains at unclear or high risk of bias; the other trial without blinding. Downgraded one level for risk of bias.