High prevalence of prediabetes and metabolic abnormalities in overweight or obese schizophrenia patients treated with clozapine or olanzapine

Abstract

ObjectiveTo assess the prevalence of prediabetes and metabolic abnormalities among overweight or obese clozapine- or olanzapine-treated schizophrenia patients, and to identify characteristics of the schizophrenia group with prediabetes.MethodsA cross-sectional study assessing the presence of prediabetes and metabolic abnormalities in schizophrenia clozapine- or olanzapine-treated patients with a body mass index (BMI) ≥27 kg/m2. Procedures were part of the screening process for a randomized, placebo-controlled trial evaluating liraglutide vs placebo for improving glucose tolerance. For comparison, an age-, sex-, and BMI-matched healthy control group without psychiatric illness and prediabetes was included. Prediabetes was defined as elevated fasting plasma glucose and/or impaired glucose tolerance and/or elevated glycated hemoglobin A1c.ResultsAmong 145 schizophrenia patients (age = 42.1 years; males = 59.3%) on clozapine or olanzapine (clozapine/olanzapine/both: 73.8%/24.1%/2.1%), prediabetes was present in 69.7% (101 out of 145). While schizophrenia patients with and without prediabetes did not differ regarding demographic, illness, or antipsychotic treatment variables, metabolic abnormalities (waist circumference: 116.7±13.7 vs 110.1±13.6 cm, P = 0.007; triglycerides: 2.3±1.4 vs 1.6±0.9 mmol/L, P = 0.0004) and metabolic syndrome (76.2% vs 40.9%, P<0.0001) were significantly more pronounced in schizophrenia patients with vs without prediabetes. The age-, sex-, and BMI-matched healthy controls had significantly better glucose tolerance compared to both groups of patients with schizophrenia. The healthy controls also had higher levels of high-density lipoprotein compared to patients with schizophrenia and prediabetes.ConclusionPrediabetes and metabolic abnormalities were highly prevalent among the clozapine- and olanzapine-treated patients with schizophrenia, putting these patients at great risk for later type 2 diabetes and cardiovascular disease. These results stress the importance of identifying and adequately treating prediabetes and metabolic abnormalities among clozapine- and olanzapine-treated patients with schizophrenia.

Risk Factors of Metabolic Syndrome in Community-Dwelling People with Schizophrenia

“…In this study, disease-related characteristics did not show statistically significant differences in the presence or absence of metabolic syndrome. These results differ from previous studies that reported that schizophrenia patients with metabolic syndrome had a longer prevalence than schizophrenia patients without metabolic syndrome and that olanzapine and clozapine were the major risk factors for developing metabolic syndrome [ 7 , 10 , 11 ]. This discrepancy may have occurred due to the fact that in this study, medications and dosage were only checked at the time of research, and it was difficult to verify the exact duration and dosage of medications that participants were taking at the community mental health care centers where data collection was conducted.…”

“…Antipsychotics used to alleviate the negative symptoms of schizophrenia have adverse effects, including increased appetite and delayed satiety [ 10 ]. In particular, clozapine and olanzapine cause metabolic disorders such as weight gain, type 2 diabetes, and cardiovascular disease [ 10 , 11 ].…”

“…Antipsychotics used to alleviate the negative symptoms of schizophrenia have adverse effects, including increased appetite and delayed satiety [ 10 ]. In particular, clozapine and olanzapine cause metabolic disorders such as weight gain, type 2 diabetes, and cardiovascular disease [ 10 , 11 ]. Therefore, assessing and managing disease-related characteristics and the lifestyle habits of community-dwelling schizophrenia patients taking antipsychotics is an essential component of preventing the development of metabolic syndrome in these patients.…”

The Effect of Long-Term Second-Generation Antipsychotics Use on the Metabolic Syndrome Parameters in Jordanian Population

“…In a recent cross-sectional study, prediabetes and metabolic abnormalities were found to be highly prevalent among schizophrenic patients taking clozapine or olanzapine [34]. Interestingly, previous reports have found that patients who are on clozapine or olanzapine are at a high risk of developing hyperlipidemia [35].…”

Effects of Smoking Status on Remission and Metabolic and Cognitive Outcomes in Schizophrenia Patients Treated with Clozapine

“…The negative effects of smoking on morbidity and premature mortality in individuals with schizophrenia are well established [16,17]. Furthermore, prediabetic conditions and metabolic abnormalities are highly prevalent among patients treated with clozapine [18], and presumably higher dosages of clozapine among smokers might be associated with a higher risk of unfavourable metabolic outcomes due to dose-dependent side effects [19,20].…”