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Novel antipsychotics and new onset diabetes
D A Wirshing1, B J Spellberg, S M Erhart
1Department of Psychiatry, West Los Angeles Veterans Affairs Medical Center, CA 90073, USA.
Biological Psychiatry
|November 3, 1998
Summary
Newer antipsychotics like clozapine and olanzapine may increase the risk of developing type 2 diabetes, especially in patients with existing risk factors. Weight gain is a significant factor in this adverse effect.
Area of Science:
- Pharmacology
- Endocrinology
- Psychiatry
Background:
- Novel antipsychotics exhibit polyreceptor affinity, differing from older agents.
- This polyreceptor affinity may contribute to adverse effects, including non-insulin-dependent diabetes mellitus.
Observation:
- Six new cases of clozapine- and olanzapine-associated diabetes were documented.
- A comparison with existing literature revealed similarities among these cases.
Findings:
- Four cases were linked to clozapine and two to olanzapine.
- Most patients (5/6) had pre-existing diabetes risk factors.
- Significant weight gain was observed in a majority of patients after initiating antipsychotic treatment.
Implications:
- Novel antipsychotics require cautious administration in patients with diabetes risk factors.
- Weight gain, potentially induced by histaminic and serotonergic antagonism, may alter glucose homeostasis.
- Serotonin1A antagonism could impair pancreatic beta-cell function, leading to hyperglycemia.