Study Identifies Elevated Diabetes Risk in Veterans With Serious Mental Illness and Psychotropic Medication Use

A large-scale analysis of over half a million veterans found that serious mental illness (SMI) and certain psychiatric medications significantly increase the risk of developing type 2 diabetes (T2D), highlighting the need for tailored metabolic monitoring and medication management in this population.

The study assessed 543 979 veterans across 10 years, analyzing the co-occurrence of T2D with schizophrenia (SZ), schizoaffective disorder (SZA), bipolar disorder (BD), and major depressive disorder (MDD). Results confirmed that SMI diagnoses were significantly associated with elevated T2D risk, even after adjusting for demographic and clinical confounders.

Using elastic net regression modeling, the researchers identified age, BMI, sex, race/ethnicity, psychiatric diagnosis, urbanicity, and psychopharmacologic exposure as major predictors of T2D. Notably, Veterans prescribed both selective serotonin reuptake inhibitors (SSRIs) and mood stabilizers had more than double the odds of T2D. “A history of exposure to both...was associated with a ~2-fold increased prevalence of T2D compared to individuals not using these medications,” the authors wrote.

Unexpectedly, first-generation antipsychotic medications were associated with higher T2D risk than second-generation agents. The authors suggest this may reflect the longer treatment duration and cumulative metabolic burden among patients with chronic illness histories. In contrast, lithium was linked to a reduced risk of T2D.

The study found that BD was minimally associated with T2D when accounting for medication exposure, suggesting that treatment effects may outweigh diagnostic effects in this group. 

“Mood stabilizing medications (excluding lithium) prescribed for BD weighed more heavily in association with T2D than did BD diagnosis,” the authors noted.

Findings also demonstrated higher T2D prevalence among Black male veterans and patients aged 70 years and older. The authors concluded that these clinical and demographic factors, combined with pharmacologic exposures, could be leveraged to identify high-risk individuals. Future work may lead to predictive biomarkers and inform safer treatment strategies for veterans with SMI.

Reference
Pless LL, Mitchell-Miland C, Seo YJ, Bennett CB, Freyberg Z, Haas GL. Psychiatric factors predict type 2 diabetes mellitus in US veterans. Schizophr. 2025;11(63). doi:10.1038/s41537-025-00616-y