Addressing Metabolic Comorbidity in Individuals With Intellectual and Developmental Disability on Antipsychotics

Abstract

Purpose/Background: Individuals with intellectual and developmental disabilities (IDDs) are at increased risk for serious metabolic comorbidities, which is further exacerbated by the high rate of antipsychotic use in this population. There is currently a lack of literature on effective treatment options for antipsychotic-induced weight gain and metabolic abnormalities in IDD. This case series reports on the clinical use of metformin in patients with IDD on antipsychotics.Methods/Procedures: We conducted a retrospective review of patients in a novel clinical service at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada for adults with IDD experiencing antipsychotic-related weight gain and other metabolic aberrations. Charts were reviewed for weight and other metabolic outcome measures before and after commencing metformin treatment.Findings/Results: In 11 patients referred to this clinic, the mean weight loss while on metformin treatment was 11.1 kg, with over 50% of the sample achieving clinically meaningful weight loss of >7%. Additional adaptive changes were observed for fasting glucose, glycated hemoglobin, triglyceride, and high-density lipoprotein cholesterol levels.Implications/Conclusions: In line with its use in severe mental illness, metformin may be a safe, effective, and accessible treatment option for patients with IDD experiencing metabolic adverse effects of antipsychotic medication. Further research and randomized controlled trials are needed to examine the efficacy of metformin in this population.

Metformin for the treatment of antipsychotic-induced metabolic disturbances in people with intellectual and developmental disabilities

“…To this point, a single clin ical case-series of 11 patients showed a mean weight loss of 11.1 (standard deviation 12.30) kg after 6 months of treatment with metformin. 18 The use of metformin has no serious safety concerns; the most common adverse effect is gastrointestinal intolerance (e.g., nausea, vomiting, diarrhea, bloating), which can be minimized by slower titration schedules, taking the drug with meals and switching to the extended-release formulation, if possible. 12 There is a rare risk of lactic acidosis with extreme overdose; 19 therefore, metformin is usually discouraged for patients with severe liver, kidney or cardiovascular dysfunction.…”