Why antipsychotics cause diabetes

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However, while some of the atypical drugs are better tolerated, they also increase the incidence of diabetes. In patients younger than 40 years of age, the odds ratio for developing diabetes is 1. Table 1: Classification of antipsychotic medications available in Australia a. Not all antipsychotics increase the risk of diabetes to the same extent.

The mechanisms responsible for the elevated risk of diabetes associated with some antipsychotics are not fully understood. Holt 1, 2. Author information Copyright and License information Disclaimer. Corresponding author. This article has been cited by other articles in PMC. Abstract Purpose of Review The prevalence of diabetes is 2—3-fold higher in people with severe mental illness than the general population.

Recent Findings Although there is an increased risk of diabetes in people with first-episode psychosis, the prevalence increases rapidly after antipsychotics are started.

Summary It is important to implement measures to prevent diabetes, to screen for diabetes to ensure prompt diagnosis and to provide effective diabetes care. History of Antipsychotics The discovery of antipsychotics 70 years ago transformed the lives of people with psychosis.

Table 1 Risk of weight gain, diabetes and receptor affinities of selected first- and second-generation antipsychotics. Open in a separate window. Challenges in Determining Causality As genetics, environmental and disease-specific effects may all contribute to the increased risk of diabetes in people with psychosis, it is difficult to assess the degree, if any, to which an antipsychotic has contributed to hyperglycaemia [ 9 ].

Clinical Evidence Publications over the last 5 years largely confirm what we previously knew rather than adding substantially new insights; nevertheless, the studies have extended the reach by assessing longer duration of antipsychotic use and new populations and have added information on newer antipsychotics. Adolescents and Young Adults The relative risks for diabetes appear to be higher in adolescents and young adults. Gestational Diabetes There is an emerging literature on the effect of antipsychotics on gestational diabetes.

Mechanisms The type of diabetes that occurs in the vast majority of people taking antipsychotics is type 2 diabetes, and there is no evidence that antipsychotics alter islet autoimmunity or induce type 1 diabetes [ 26 ]. Insulin Resistance Weight Gain Nutrient excess is a key driver of insulin resistance.

Direct Effect on Insulin Resistance The mechanisms underlying the development of insulin resistance are not fully understood and may occur at many levels of insulin signalling. Mitigating the Effects of Antipsychotics on Diabetes Antipsychotics are the mainstay of the treatment of severe mental illness. Prevention of Diabetes Lifestyle Randomised controlled trials in the general population have demonstrated the effectiveness of lifestyle intervention to prevent diabetes [ 47 — 51 ].

Pharmacotherapy Metformin and orlistat reduce incident diabetes in the general population [ 51 , 59 ]. Management of those with Diabetes Diabetes should be generally managed in people taking antipsychotics as for the general population. Conclusion Antipsychotics play an essential part of the management of people with severe mental illness; however, this comes at the cost of an increased risk of weight gain and, for a minority, diabetes.

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