Atypical antipsychotics and diabetes mellitus

Abstract

Numerous findings point towards a higher incidence of diabetes mellitus and cardio-vascular risk factors among patients with schizophrenia compared with the general population. The introduction of atypical antipsychotics, which are much more effective than classic neuroleptics in the treatment of schizophrenia, was associated with an increase of (sometimes severe) high blood sugar and diabetes cases. The mechanisms hypothesized to be involved in the "diabetogenic effect" of atypical antipsychotics are the facilitation of weight gain and the decrease of sensitivity to insulin. There are important differences among antipsychotics as far as both their psychotropic profiles and the magnitude of such so called "diabetogenic" effects are concerned. Usually, risk factors of diabetes precede and predict the development of diabetes mellitus. In the absence of a proven effect on beta pancreatic cells, it appears that atypical antipsychotics facilitate the development of diabetes in individuals at high risk who do not have the capacity to increase their secretion of insulin to a sufficient extent as to compensate the resistance of tissues to the action of insulin. The monitoring of patients under treatment with atypical antipsychotics, in particular of patients with risk factors of diabetes, and the choice of antipsychotics in relation with the particular psycho metabolic features of patients, are the recommended attitude in order to increase the benefit and decrease the risk of treatment.