ANTIPSYCHOTICS ASSOCIATED WITH THE DEVELOPMENT OF TYPE II DIABETES IN ANTIPSYCHOTIC-NAÏVE SCHIZOPHRENIA PATIENTS

Jimmi Nielsen (1) , Søren Skadhede (1) , Christoph U Correll (1)

1 Unit for Psychiatric Research

Diabetes mellitus occurs in schizophrenia patients at higher rates than in the general population Reasons for this elevated risk are poorly understood and have not been examined prospectively in antipsychotic-naïve, first episode patients. This study aims to determine antipsychotics associated with diabetes development in antipsychotic-naïve schizophrenia patients. All antipsychotic-naïve patients diagnosed with schizophrenia in Denmark between 01.01.1997 and 31.12.2004, followed until 31.12.2007, allowing for >3 years follow-up, unless death or diabetes onset occurred. Risk factors for the time to diabetes onset were assessed, including antipsychotics taken for at least 180 defined daily doses in the first year after first antipsychotic prescription ("initial treatment"). Risk factors for diabetes incidence were assessed, including antipsychotic use within three months before diabetes onset or study end ("current treatment"). Of 7,139 patients, followed for 6.6 years (47,297 patient years), 307 developed diabetes (annual incidence rate: 0.65%). Time to diabetes onset was significantly shorter in patients with higher age (HR:1.03, CI:1.02-1.03) and those with "initial" treatment of olanzapine (HR:1.41, CI:1.09-1.83), mid-potency first-generation antipsychotics (FGAs) (HR:1.60, CI:1.07-2.39), antihypertensive (HR:1.87, CI:1.13-3.09) or lipid lowering drugs (HR:4.67, CI:2.19-10.00). Significant factors associated with diabetes within three month of its development included treatment with low-potency FGAs (OR:1.52, CI: 1.14-2.02), olanzapine (OR:1.44, CI:1.98-1.91) and clozapine (OR:1.67, CI:1.14-2.46), while aripiprazole was associated with lower diabetes risk (OR:0.51, CI:0.33-0.80). In addition to general diabetes risk factors, like age, hypertension and dyslipidemia, diabetes is promoted in schizophrenia patients by initial and current treatment with olanzapine and mid potency first-generation antipsychotics, as well as by current treatment with or low potency first generation antipsychotics and clozapine, whereas current aripiprazole treatment reduced diabetes risk. Patients discontinuing olanzapine or mid-potency FGA had no increased risk of diabetes compared to patient not treated with the drugs at anytime.

Mots clés: Psychopharmacology; Epidemiology; First-episode; antipsychotic naive; diabetes; olanzapine; clozapine; Schizophrenia; Antipsychotics; Eating; Metabolic Disorders

Jimmi Nielsen, Søren Skadhede, Christoph U Correll. ANTIPSYCHOTICS ASSOCIATED WITH THE DEVELOPMENT OF TYPE II DIABETES IN ANTIPSYCHOTIC-NAÏVE SCHIZOPHRENIA PATIENTS. Neuropsychopharmacology, 2010, ⟨10.1038/npp.2010.78⟩. ⟨hal-00542221⟩