Phenomenology of and risk factors for new-onset diabetes mellitus and diabetic ketoacidosis associated with atypical antipsychotics: an analysis of 45 published cases.
Phenomenology of and risk factors for new-onset diabetes mellitus and diabetic ketoacidosis associated with atypical antipsychotics: an analysis of 45 published cases.
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DOI：
10.1023/a:1015228112495
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发表时间：
2002-03-01
期刊：
影响因子：
--
通讯作者：
Jeste, Dilip V
中科院分区：
文献类型：
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作者：
Jin, Hua;Meyer, Jonathan M;Jeste, Dilip V
病例报告和小型回顾性研究表明，非典型抗精神病药物可能与新发II型糖尿病（DM）或糖尿病酮症酸中毒（DKA）相关;然而，这些报告通常提供的人口统计学变量（如年龄、性别、种族、与体重增加的关系和时间进程）信息有限或没有提供。我们分析了45例已发表的新发DM或DKA病例，这些病例在开始非典型抗精神病药物治疗后发生。在45例患者中，20例接受了氯氮平，19例接受了奥氮平，3例接受了奎替利嗪，3例接受了利培酮。87%的患者为男性，47%为非洲裔美国人。42%的患者表现为DKA，50%的患者在出现DM或DKA时体重没有增加，尽管84%的患者在抗精神病药物治疗前超重。84%的患者在开始使用非典型抗精神病药物后6个月内出现，59%在3个月内出现。DKA队列的年龄明显更小，基线时超重较少，女性比例高于单纯DM患者，在种族分布、体重增加、DM家族史或暴露于非典型药物的持续时间方面无显著差异。临床医生应了解服用非典型抗精神病药物患者新发DM和DKA的潜在风险，并利用适当的临床和实验室监测来预防严重不良事件。
Case reports and small retrospective studies suggest that atypical antipsychotic agents may be associated with new-onset Type II diabetes mellitus (DM) or diabetic ketoacidosis (DKA); however, these reports often provide limited or no information on demographic variables such as age, gender, ethnicity, relationship to weight gain, and time course. We analyzed 45 published cases of new-onset DM or DKA for which followed initiation of atypical antipsychotic treatment. Of the 45 patients, 20 had received clozapine, 19 olanzapine, 3 quetiapine, and 3 risperidone. Eighty-seven percent patients were male, and 47% African American. Forty-two percent of these patients presented as DKA, and 50% manifested no weight gain at time of presentation with DM or DKA, although 84% were overweight before antipsychotic therapy. Eighty-four percent presented within 6 months and 59% within 3 months of commencing atypical antipsychotics. The DKA cohort had significantly younger age, less overweight at baseline, and higher proportion of women than did those with DM alone, without significant differences in distribution of ethnicity, weight gain, family history of DM, or duration of exposure to atypical agents. Clinicians should be aware of the potential risks of new-onset DM and DKA in patients taking atypical antipsychotics, and utilize appropriate clinical and laboratory monitoring to prevent serious adverse events.