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Atypical Antipsychotic-Induced Diabetes Mellitus

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Abstract

Atypical antipsychotics offer significant improvements over older, conventional antipsychotic agents. However, recently the newer agents have been linked to medical morbidity including hyperglycaemia, diabetes mellitus, bodyweight gain and abnormal lipid levels. Even more concerning, because of a significant risk of death, there have been numerous case reports of patients treated with clozapine or olanzapine developing diabetic ketoacidosis shortly after initiation of the drug.

Much of the information concerning the medical morbidity of diabetes mellitus is based on case reports, retrospective chart reviews, naturalistic studies and cross-sectional studies. While definitive studies have yet to be reported, mounting evidence suggests that the atypical antipsychotic agents, particularly clozapine and olanzapine, may significantly impair glucose metabolism and increase the risk of diabetes in patients with schizophrenia. Diabetic ketoacidosis, although it appears to be uncommon, is of great concern secondary to the risk of death.

Patients treated with atypical antipsychotic agents should be routinely screened for diabetes and other metabolic abnormalities including raised lipid levels. Patients with risk factors for diabetes should be monitored more closely. Reports and clinical experience suggest that in a case of atypical antipsychotic-associated diabetes or diabetic ketoacidosis, discontinuation of the antipsychotic agent may result in complete resolution of the hyperglycaemia and diabetes.

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Acknowledgements

The author would like to thank Ms Christina Borba and Ms Leah Namey for assistance in manuscript preparation.

The author has received funding from the NARSAD Young Investigator Award from the National Alliance for Research on Schizophrenia and Depression, Great Neck, N.Y; grant M01-RR-01066 from the National Institutes of Health, Rockville, MD, US; and investigator-initiated unrestricted research grants from Eli Lilly, Janssen, Pfizer and AstraZeneca.

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  1. Psychotic Disorders and Schizophrenia Research Program, Massachusetts General Hospital and Harvard Medical School, Freedom Trail Clinic, 25 Staniford Street, Boston, Massachusetts, 02114, USA

    David C. Henderson

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Henderson, D.C. Atypical Antipsychotic-Induced Diabetes Mellitus. Mol Diag Ther 16, 77–89 (2002). https://doi.org/10.2165/00023210-200216020-00001

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