Diabetes mellitus is
widely becoming a serious health issue globally. Antipsychotics have been used
for disrupting glucose metabolism and causing diabetes mellitus.
are known to have metabolic repercussions such as weight gain, dyslipidemia and
hyperglycemia. Not all antipsychotic agents are associated with weight gain
such as ziprasidone and aripiprazole.
It therefore, is a
wise decision to select a low-risk antipsychotic in people predisposed to high
risk of diabetes.
In the United States,
diabetes mellitus is the seventh common cause of death and is the chief cause
of kidney failure, nontraumatic limb amputation and new onset blindness.
predisposes people to the threat of of cardiovascular ailments and is a largely
responsible for prevalence of heart diseases and stroke.
Statistics suggest that
diabetes mellitus affects about 8.3 percent of US nationals and this percentage
is growing at an alarming rate.
are known to cause type 2 diabetes mellitus. Antipsychotic drugs are used in
the treatment of schizophrenia or affective disorders.
observed that patients receiving medication for schizophrenia had higher
chances of type 2 diabetes mellitus as compared to other individuals.
study, conducted with schizophrenia outpatients revealed the presence of type 2
diabetes mellitus prevalence rate of 11.5 percent.
'A cohort study of
antipsychotic-naïve patients followed participants for 3 years after the
initiation of antipsychotic therapy. After 3 years of follow-up, the incidence
rate of DM was found to be 0.6 percent per patient-year.'
observed a relatively shorter onset of diabetes in older patients as compared
to younger patients.
diabetes mellitus commonly affects people with schizophrenia, psychotic
depression, bipolar disorder, autism, dementia, or developmental disorder.
Some other less
frequent uses of antipsychotic medication leading to the development of
treatment-induced metabolic disturbances, are delirium, post-traumatic stress
disorder (PTSD), aggressive behavior and personality disorder.
Though the risk
factors for the development of antipsychotic-induced diabetes mellitus are
quite complex, but sedentary lifestyle, genetic causes, pharmacologic
properties of antipsychotic agents and worsening metabolic homeostasis can lead
to prevalence of diabetes mellitus.
that antipsychotic agents can cause weight gain, dyslipidemia and type 2
disturbs metabolism and can cause obesity.
In mentally ill people,
metabolic syndrome is quite common besides lifestyle factors such as increased
food intake, high carbohydrates consumption, limited physical activity tobacco
The exact association
of antipsychotics and weight gain is unknown however; it is believed that
antipsychotics can result in weight gain dyslipidemia and hyperlipidemia by
binding to serotonin (5-HT), dopamine, norepinephrine and/or histamine
'Stimulation of 5-HT1A
is associated with an increase in food intake whereas stimulation of 5-HT2C is
related to a decrease in food intake. Antagonism of the 5-HT2C receptor for
histamine can, in turn, lead to an increase in food intake, with most SGAs
possessing 5-HT2C antagonist activity.'
Olanzapine has high
affinity for histamine receptors while aripiprazole and ziprasidone have
relatively low affinity for receptor affinities.
patient monitoring for the development of dyslipidemia, weight gain, and DM
have been published.6 They consider the potential metabolic risks when
initiating an SGA; patient, family, and caregiver education; baseline
screening; and referral to a specialist, if needed, as key components of
patient care.6 As weight gain is considered a precipitating factor for the
development of DM and dyslipidemia, monitoring of weight changes with treatment
is an important screening measure.'
According to the
American Diabetes Association, the American Psychiatric Association, the
American Association of Clinical Endocrinologists, and the North American
Association for the Study of Obesity, baseline and follow-up is essential for
monitoring the antipsychotic-induced DM. 'According to the consensus statement,
screening measures are recommended to be obtained before or soon after the
initiation of antipsychotic medication.'
Clinicians rare asked
to record patient's height and weight (BMI) prior and after the treatment.
'Fasting plasma glucose and blood pressure are assessed at baseline, at 3
months, and then annually, while lipids are assessed at baseline, at 3 months,
and then every 5 years. If patients are at higher risk to develop DM or
hypertension, more frequent monitoring is advised. Using these measures,
clinicians can better assess patients' baseline status for weight (overweight
defined as BMI 25-29), prediabetes (fasting plasma glucose 100-125 mg/dL) or DM
(fasting plasma glucose ≥126 mg/dL), hypertension (>140/90 mmHg), or
dyslipidemia to help determine their risk status and the contribution and/or
causation of antipsychotic therapy.'
The clinicians can
decide regarding the use of appropriate antipsychotic drugs depending upon the
presence of metabolic disorder.
Prompt referral for
the management of diabetes mellitus from the experienced physician is advised,
if any symptoms of hyperglycemia are present.
antipsychotic (SGAs) such as olanzapine, aripiprazole, risperidone, clozapine
and ziprasidone can result in metabolic syndrome while first generation
antipsychotics (FGAs) can contribute to extrapyramidal symptoms (EPS) such as
akathisia, dystonia, pseudoparkinsonism, and late-onset tardive dyskinesia.
clozapine are regarded as the worst offenders for hyperglycemia, weight gain
The scientists noted
that lower-risk antipsychotic such as ziprasidone or aripiprazole should be
given to people at high risk or with pre-existing diabetes.
In case of
hyperglycemia, weight gain or dyslipidemia, low-risk antipsychotics should be
Diabetes is becoming a
pandemic and self-monitoring of this metabolic disorder is encouraged.
Pharmacists can encourage and counsel suitable self-monitoring in patients
receiving antipsychotic drugs. They cat as catalysts and play an important role
in recognition and intervention to improve the quality of life.
In nutshell it can be
said that appropriate monitoring clinician's awareness and reporting are
crucial in the early diagnosis and detection of antipsychotic-induced diabetes
Antipsychotic-Induced Diabetes Mellitus; Theary
Chhim et al; US Pharmacist