During the last years, a contribution of antipsychotic drugs in the increase of diabetes prevalence in schizophrenic population has been repetitively suggested. Specifically, atypical antipsychotic drugs have been associated with new-onset diabetes and weight gain.1–4 These side effects have involved such agents as clozapine, olanzapine, quetiapine, and a combination of clozapine and quetiapine. In April of 2003, the Wall Street Journal ran a front page article on Zyprexa and the other Atypical Antipsychotics with respect to their connection to cases of Type 2 Diabetes ( sometimes called “adult onset diabetes”). Under the weakest study design (none of the above enhancements), all antipsychotics were associated with significantly higher odds of diabetes relative to no treatment (p < 0.05). The causative link between antipsychotic drugs and diabetes is coherent with our understanding of diabetes and there are other analogies. Depression and antidepressant, cholinesterase inhibitor, and valproate use were independently associated with increases in fasting glucose. After controlling for demographic and clinical variables, still no significant difference was noted among the agents.
John W. Drug safety studies are usually large series of case reports. Therefore, establishing a routine of annual metabolic monitoring is important so that metabolic changes can be tracked and dealt with as they arise throughout the course of treatment. There is debate about who should be responsible for metabolic monitoring. Antipsychotic medications reduce both the frequency and intensity of relapses of acute episodes presented by the disease state and protect against long-term deterioration. At the same time, experience has shown that systems and structures need to be established to support routine monitoring. In practice, basic psychiatric care may need to be augmented by physical health clinics and/or metabolic clinics as well as by regular audits to ensure adherence with guidelines and appropriate follow-through.