Association Between Antipsychotic Medication Use and Diabetes

Abstract

Purpose of review: The prevalence of diabetes is 2-3-fold higher in people with severe mental illness than the general population. There are concerns that antipsychotics increase the risk of diabetes. This review will examine the latest epidemiological studies linking antipsychotics and diabetes, as well as the mechanisms underlying the association and the clinical implications to minimise the impact of antipsychotics on metabolic health.

Recent findings: Although there is an increased risk of diabetes in people with first-episode psychosis, the prevalence increases rapidly after antipsychotics are started. Antipsychotics likely increase the risk of diabetes through weight gain and directly by adversely affecting insulin sensitivity and secretion. It is important to implement measures to prevent diabetes, to screen for diabetes to ensure prompt diagnosis and to provide effective diabetes care. Further research is needed to understand how antipsychotics cause diabetes and to improve the clinical management of diabetes in people with severe mental illness.

Keywords: Antipsychotics; Diabetes; Insulin resistance; Weight gain; β-cell dysfunction.

Fig. 1

The potential mechanisms by which antipsychotics are associated with an increased risk of diabetes. a Antipsychotics are used in individuals with severe mental illness who are increased risk of diabetes because of genetic, lifestyle and disease effects. In this scenario, the relationship between the antipsychotics and diabetes is not causal. b Antipsychotics increase the risk of diabetes by increasing body weight, inducing insulin resistance and impairing insulin secretion in a causal manner. The development of diabetes in any one individual is likely to be a combination of both possibilities