Diabetic Ketoacidosis Associated With Second Generation Antipsychotics: A Case Study and Review of Literature

Abstract

Objective: Second-generation antipsychotics (SGAs) have revolutionized the treatment of psychiatric disorders, but are associated with significant metabolic risks, including diabetes and hyperglycemic crises. This review explores the complex interplay between antipsychotics, diabetes, and hyperglycemic crises, highlighting the mechanisms underlying SGA-induced diabetes.

Methods: We present the case of a patient with schizophrenia who was taking antipsychotic medication and was admitted to the emergency room due to the sudden onset of diabetic ketoacidosis (DKA) without any history of diabetes. We extensively searched databases, including Elsevier, PubMed, IEEE, SpringerLink, and Google Scholar, for papers on the effects of antipsychotic drugs on DKA from 2002 to 2021. We focused on DKA, hyperglycemia, and atypical antipsychotics, and retrieved 117 papers. After full-text review, 32 papers were included in this comprehensive review.

Results: DKA was significantly more frequent in patients taking SGAs. Antipsychotics can induce insulin resistance either directly or through the onset of obesity. Antipsychotics can reduce insulin secretion from pancreatic β-cells, which is associated with absolute insulin deficiency.

Conclusion: As the use of antipsychotics continues to increase, understanding their risks and mechanisms is crucial for clinicians to enable informed treatment decisions and prevent potentially life-threatening complications.

Keywords: Antipsychotics; Diabetic ketoacidosis; Hyperglycemia.

Figure 1.

Flow chart illustrating the clinical progression of the case patient. ER, emergency room; NP, neuropsychiatry ward; BST, blood sugar test; DM, diabetes mellitus.

Figure 2.

Pathophysiology of hyperglycemic emergencies and antipsychotics. Second-generation antipsychotics can induce insulin resistance either directly or through obesity. Increased food intake can lead to obesity and insulin resistance. Moreover, antipsychotics can reduce insulin secretion, which is associated with absolute insulin deficiency, from β-cells. FFAs, free fatty acid.