In Reply We thank Bortolasci, Mangurian, and Cui and their respective colleagues for their comments on our article.1 Both type 2 diabetes and schizophrenia have complex pathoetiologies with genetic and environmental roots, and their letters reflect this.
We agree with Bortolasci and colleagues that mitochondrial dysfunction is a potential mechanism underlying the association between schizophrenia and glucose dysregulation. Regardless of mechanism, the findings of our meta-analysis are a reminder to clinicians that altered glucose regulation should be considered from the first psychotic episode. Large prospective longitudinal studies are required to define the role of modifiable factors.
Pillinger T, Beck K, Howes O. First-Episode Schizophrenia and Diabetes Risk—Reply. JAMA Psychiatry. 2017;74(7):763. doi:10.1001/jamapsychiatry.2017.0765