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Antipsychotic Treatment Benefits for DM Population

New study shows that taking anti-psychotic medications decreased diabetic complications.

It is known that most patients with schizophrenia are more than likely to develop diabetes, which ultimately can lead to a considerable risk of high cardiovascular complications. It is well established that patients who are taking antipsychotic agents, especially those with schizophrenia, are at an increased risk for developing more detrimental conditions, which ultimately can lead to increased susceptibility to cardiovascular disease and hyperlipidemia. The newer generation of atypical antipsychotic medications have been strongly associated with increases in weight and subsequent metabolic effects. Though it’s not clear why schizophrenia patients are at an increased risk for developing type 2 diabetes, there are a number of risk factors that make them more susceptible, including: family history, increased body mass index, a sedentary lifestyle and of course, the use of antipsychotic medications.

However, a new study performed at the Taiwan National Health Insurance Research Database investigated the relationship between antipsychotic treatment and the consequences for patients with diabetes. The research focused on the effects of switching antipsychotic treatment on the reduction of diabetic complications in recently diagnosed diabetics. According to their findings, in comparison to patients who had no antipsychotic therapy in the six-month trial period, patients who were consistent with their use of the medications had an overall lower risk of diabetic complications and decreased risk of macrovascular complications, ultimately associated with lowered risk of mortality. Furthermore, the research showed that switching antipsychotic therapy or the failure to start patients on antipsychotic medications could potentially exacerbate psychiatric symptoms, ultimately leading to further diabetic complications. The findings discussed, however, need to be further supported through additional research.

The effective management of both diabetes and psychiatric symptoms–especially in the case of schizophrenia–requires careful and serious consideration from both psychiatrists and endocrinologists. Though antipsychotic medications may contribute to side effects that may potentiate diabetic complications, it is important to note that psychiatric conditions such as schizophrenia are also serious illnesses, which cannot go unmanaged. Antipsychotic medications reduce both the frequency and intensity of relapses of acute episodes presented by the disease state and protect against long-term deterioration. Managing diabetes in this patient population is challenging due to the person’s loss of insight, loss of initiative and cognitive deficits. For most patients undergoing active psychosis, it is difficult to ensure they will be actively monitoring their blood glucose concentrations, calculating correct insulin doses and managing their food intake.

Numerous strategies have been outlined to aid in both initiating antipsychotic therapy and management of diabetes. Diabetes prevention should start with the admission of an atypical antipsychotic medication with a lower-risk profile (including ziprasidone or aripiprazole), as well as encouraging patients to exercise daily for at least 30 minutes while maintaining a balanced diet. Recent studies have found that the use of metformin as part of a patient’s overall drug regimen has helped prevent certain metabolic changes alongside treating atypical antipsychotic-induced type 2 diabetes. Long-term complications associated with diabetes may be avoided if patients are continuously monitored and treated for metabolic disturbances of any kind and continue with their antipsychotic medications.

Practice Pearls:

  • Psychotic ailments and their management are coupled with an increased rate of diabetes and worsening blood glucose control.
  • Management of psychosis takes precedence over trepidations concerning the potential metabolic consequences of treatment.
  • Precautionary measures along with treatment of hyperglycemia and other metabolic issues are essential in this patient population.

Boggs, Will. “Antipsychotic Treatment of Schizophrenia Reduces Risk of Diabetic Complications.”Medscape Pharmacists. N.p., 14 Jan. 2016. Web. 25 Jan. 2016.

Lean, Michael. “Patients on Atypical Antipsychotic Drugs.” American Diabetes Association 26 (2003): 1597-605. Diabetes Care. Web. 25 Jan. 2016.

Wu, Chi-Shin. “Association Between Antipsychotic Treatment and Advanced Diabetes Complications Among Schizophrenia Patients With Type 2 Diabetes Mellitus.” Oxford Journals 10 (2015): n. pag. PubMed. Web. 25 Jan. 2016.

Researched and prepared by Javeria Fayyaz, Doctor of Pharmacy Candidate LECOM College of  Pharmacy, reviewed by Dave Joffe, BSPharm, CDE