The Risk of Diabetes During Olanzapine Use Compared With Risperidone Use

Caro, J Jaime; Ward, Alexandra; Levinton, Carey; Robinson, Kimberly A.

doi:10.4088/jcp.v63n1208

Cited by 124 publications

(90 citation statements)

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“…Several reported observational analyses have used large administrative or health plan databases to test the strength of the association between treatment with specific antipsychotic medications and the presence of T2DM (64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80). Their common approach has been to identify the association within a database between the use of specific antipsychotic medications and the presence of one or more surrogate indicators of T2DM (for example, prescription of an oral hypoglycemic medication or relevant ICD-9 codes).…”

Section: Level 2 Evidence: Observational Database Analysesmentioning

confidence: 99%

The Metabolic Effects of Antipsychotic Medications

2006

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Objectives: To review current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and type 2 diabetes mellitus (T2DM) and to examine the relation of adiposity to medical risk. Methods:We identified relevant publications through a search of MEDLINE from the years 1975 to 2006, using the following primary search parameters: "diabetes or hyperglycemia or glucose or insulin or lipids" and "antipsychotic." Meeting abstracts and earlier nonindexed articles were also reviewed. We summarized key studies in this emerging literature, including case reports, observational studies, retrospective database analyses, and controlled experimental studies.Results: Treatment with different antipsychotic medications is associated with variable effects on body weight, ranging from modest increases (for example, less than 2 kg) experienced with amisulpride, ziprasidone, and aripiprazole to larger increases during treatment with agents such as olanzapine and clozapine (for example, 4 to 10 kg). Substantial evidence indicates that increases in adiposity are associated with decreases in insulin sensitivity in individuals both with and without psychiatric disease. The effects of increasing adiposity, as well as other effects, may contribute to increases in plasma glucose and lipids observed during treatment with certain antipsychotics. Conclusion:Treatment with certain antipsychotic medications is associated with metabolic adverse events that can increase the risk for metabolic syndrome and related conditions such as prediabetes, T2DM, and cardiovascular disease. Limitations· Currently, knowledge of the cost-effectiveness of different interventions to lower metabolic risk is limited. · Questions remain concerning how to implement clinical strategies that would improve quality and disparities of care in mental illness. · Future studies are needed to identify the mechanisms that allow medications to cause adiposity and changes in insulin sensitivity.

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Section: Level 2 Evidence: Observational Database Analysesmentioning

confidence: 99%

The Metabolic Effects of Antipsychotic Medications

2006

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“…The second theme is that treatment with secondgeneration antipsychotics is associated with more diabetes than treatment with a conventional antipsychotic [14]. These studies show that the strength of the association is smaller with most studies showing hazard ratios of less than 1.5 [2,17,21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36]. These studies may underestimate any risk, as they assume that conventional antipsychotics have a neutral effect on diabetes.…”

Section: Analogymentioning

confidence: 99%

Antipsychotic drugs and diabetes—an application of the Austin Bradford Hill criteria

Holt

Peveler

2006

Diabetologia

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There is concern that antipsychotic drugs cause diabetes. Although there has been an explosion in the quantity of literature about this subject, it remains confusing and inconsistent. To assess whether the association between antipsychotic drugs and diabetes is causative, we applied the Austin Bradford Hill criteria to the available evidence. In support of a causative relationship, there is temporality for some cases of diabetes, and there is a biologically plausible explanation. The causative link between antipsychotic drugs and diabetes is coherent with our understanding of diabetes and there are other analogies. However the strength of association is weak, there is lack of consistency or specificity, and there is little evidence to support a biological gradient. We should therefore conclude that the evidence surrounding a causative link between antipsychotic drugs and diabetes is inconclusive. Moreover, the risk is probably low and the attributable risk of developing diabetes is greater for traditional risk factors such as family history, ethnicity, obesity and ageing than it is for receiving an antipsychotic drug. Consequently, the majority of patients receiving second-generation antipsychotics will not develop diabetes as a result of their medication.

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“…On the one hand, many studies have suggested a role of (certain) atypical antipsychotics in the occurrence of metabolic abnormalities, both case reports [22][23][24][25][26], cross-sectional or retrospective studies [27,28] as prospective studies [29,30]. On the other hand, other studies have provided evidence for an increased prevalence of central obesity [31] and glucose abnormalities such as impaired fasting glucose and insulin resistance [32] in drug-naïve first-episode patients, suggesting that metabolic abnormalities are an inherent part of schizophrenic illness.…”

Section: Introductionmentioning

confidence: 99%