Anti-Psychotic
Drugs May Reduce & Not Increase Diabetes Risk
in Mentally Ill
Drugs may reduce the risk for diabetes and not
cause it as originally believed.
Two
related University at Buffalo studies examining
the incidence of diabetes and related conditions
among patients suffering from schizophrenia or
bipolar disorder indicate that it is the illness
-- not the atypical antipsychotic medications
used to treat the disorders -- that contributes
to the increased incidence of diabetes in these
patients.
The
findings suggest that the atypical antipsychotic,
second-generation antipsychotic medications that
became available after 1991, such as Clozaril
(clozapine), Zyprexa (olanzapine), Risperdal (risperidone)
and Seroquel (quetiapine fumarate), may actually
have a protective effect against diabetes.
The
results seem to contradict growing fears that
antipsychotic medications cause the increased
rate of diabetes in patients with these mental
illnesses.
The
studies were conducted by researchers in the Department
of Pharmacy Practice in the UB School of Pharmacy
and Pharmaceutical Sciences.
One
study will be presented May 2 in a poster session
at the annual conference of the College of Psychiatric
and Neurologic Pharmacists in Charleston, S.C.
The other will be presented May 21 in a poster
session at the annual conference of the American
Psychiatric Association in San Francisco.
Based
on the findings, the UB researchers conclude that
psychiatric care for patients with the two disorders
should be modified to include routine screening
for diabetes (adult onset or type 2), hypertension
and obesity. They also suggest that severe mental
illness should be listed, along with family history
of diabetes, as a primary risk factor for diabetes.
"According
to our findings in these studies, an association
between schizophrenia and bipolar disorder and
diabetes seems to exist independent of any antipsychotic
use," said Terrance Bellnier, R.Ph., assistant
clinical professor of pharmacy practice, director
of psychiatric pharmacy practice at UB and co-author
of the study.
"The
question is, whether these drugs induce diabetes
at the same rate, or it's the mental illness itself
-- what we're using the drugs for -- that induces
diabetes," Bellnier said. "That's the
question we tried to answer."
More
than 2 million Americans suffer from schizophrenia
and the same number suffer from bipolar disorder.
Diabetes is estimated to affect more than 15 million
Americans.
Data
in the study to be presented at the annual conference
of the American Psychiatric Association demonstrate
that an increased incidence of diabetes among
patients with schizophrenia or bipolar disorder
predates the use of antipsychotic medications
to treat the disorders.
According
to the results, the rate of diabetes among the
patients was 20.9 percent, or 10 times that reported
at that time for the general population. The incidence
of hypertension was 29.1 percent, compared to
16.5 percent in the general population, and the
incidence of "overweight" was 28.2 percent
versus 21.8 percent in the general population.
The
other UB study compared in a matched-pair analysis
the data for these untreated patients with data
from 569 patients admitted to a state psychiatric
hospital between 1999 and 2002, all of whom were
treated with atypical antipsychotics.
In
patients treated with the medications, the rate
of diabetes was 10.4 percent, half of what was
reported in the group that received no medication,
and slightly more than twice the rate reported
in the general population.
The
second study also found that the incidence of
hypertension in the treated patients was 15.6
percent, compared to 7.2 percent in the general
population, while hypertension in the untreated
population was nearly twice as prevalent.
"When
you effectively treat schizophrenia and bipolar
disorder, you reduce most of these other metabolic
risk factors," said Bellnier.
"While
the incidence of diabetes has actually gone up
in the general population since the 1940s and
1950s, our study shows it has gone down significantly
in patients being treated with antipsychotic medications,
so these antipsychotic drugs may actually have
a protective effect," he said.
According to Bellnier, it is possible that hypercortisolemia,
the elevated levels of cortisol -- the hormone
secreted by the adrenal gland in response to stress
-- may contribute to metabolic syndrome in severely
mentally ill patients. "When you effectively
treat these disorders and therefore reduce the
psychotic and manic episodes associated with the
elevation of cortisol, then you may also be protecting
them from diabetes," he said.
According
to the study's authors, one metabolic disturbance
did increase with the use of antipsychotic medications
and that was the incidence of patients considered
overweight.
While
untreated patients had an incidence of "overweight"
of 28.2 percent, versus 21.8 percent in the general
population at that time, the incidence of "overweight"
in the treated population was 68.6 percent, compared
to 37 percent in the general population at that
time.
Bellnier
said this striking statistic provides strong evidence
of a connection between the use of multiple psychotrophics,
such as antipsychotics, antidepressants, mood
stabilizers and anticonvulsants, and the incidence
of overweight in severely mentally ill patients.
Still,
he noted, this single metabolic disturbance does
not account for the incidence of diabetes among
these patients.
"Obesity
alone does not explain it. You can be heavy for
years and not develop diabetes," he said.
Based
on their findings, the UB researchers conclude
that psychiatric care should be modified to include
routine screening for diabetes, hypertension and
obesity.
"An
enormous amount of energy has been wasted in trying
to blame one drug over another as the cause of
this higher risk," said Bellnier. "What
we need to do now is to raise the bar a little
in caring for these patients so that they now
receive the same routine screening for diabetes
and related conditions that the general population
receives."
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