Atypical Antipsychotics and Diabetes: Discussion and Monitoring Recommendations

Abstract

Objective: To discuss the relationship between atypical antipsychotics (AAPs) and diabetes and to report new monitoring recommendations for patients being prescribed AAPs. Data Sources: Articles were identified through searches of MEDLINE and PubMed (1966–March 2004). Search terms included hyperglycemia, diabetes, glucose, atypical antipsychotics, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Only articles published in the English language were included in the search. Additionally, bibliographies of articles cited were used to identify additional articles. Study Selection and Data Extraction: All available articles identified by the data sources were reviewed and those deemed relevant to the review were included. Data Synthesis: Information pertaining to diabetes/hyperglycemia risk in case reports and submissions to the Medwatch system prompted the FDA to require labeling changes for all AAPs. The exact relationship between AAPs and diabetes remains unclear. The association is clouded by the fact that patients with schizophrenia are, in general, at higher risk for diabetes mellitus. Sedentary lifestyle and poor dietary intake are 2 possible contributing causes of diabetes in patients with schizophrenia. Weight gain or other metabolic effects of AAPs may put patients at further risk of developing diabetes. The American Diabetes Association, American Psychiatric Association, American Association of Clinical Epidemiologists, and North American Association for the Study of Obesity have released a joint consensus statement addressing some of the concerns related to AAP use. Conclusions: Because of the apparent increased risk of diabetes in patients taking AAPs, monitoring weight, fasting blood glucose, blood pressure, and lipids should be a part of the baseline assessment and ongoing care.