Antipsychotics and diabetes: case reports and cohort studies

This article reviews case reports and cohort studies involving antipsychotics and diabetes. The first part describes early case reports of new-onset glucose intolerance associated with chlorpromazine and lithium. The rest of the article presents findings from a literature review concerning atypical antipsychotics and the development of de novo diabetes mellitus or the exacerbation of already diagnosed diabetes mellitus. Evidence is presented from 3 types of sources: 1) case reports, 2) pharmacovigilance studies, and 3) retrospective reviews of treatment databases. The strengths and limitations of each of these methods are also discussed. Detailed tables are provided summarizing the findings from all 3 types of studies concerning all the currently available atypical antipsychotics. A discussion is included on the evidence for an association between atypical antipsychotics and an increased risk for diabetes mellitus. Further research is recommended to address important unanswered questions, such as what factors may confer an increased risk for patients with schizophrenia to develop diabetes.