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Journal of Psychopharmacology
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A prospective study of glycaemic status in anti-psychotic-treated patients

P. Mackin

School of Neurology, Neurobiology and Psychiatry, Newcastle University, Newcastle upon Tyne, UK, paul.mackin{at}ncl.ac.uk

D. Bishop

School of Neurology, Neurobiology and Psychiatry, Newcastle University, Newcastle upon Tyne, UK

HM Watkinson

School of Neurology, Neurobiology and Psychiatry, Newcastle University, Newcastle upon Tyne, UK

IN Ferrier

School of Neurology, Neurobiology and Psychiatry Newcastle University, Newcastle upon Tyne, UK

Anti-psychotic drugs, particularly the second generation, or `atypical' agents, have been implicated in the development of metabolic dysfunction such as diabetes mellitus. There is a paucity of longitudinal data on the natural history of glucose homeostasis in anti-psychotic-treated patients, and there are no universally accepted strategies for managing worsening glycaemic control in this population. Notwithstanding, several guidelines recommend switching to a `lower risk' agent if patients develop worsening glycaemic control during anti-psychotic treatment. We prospectively followed a cohort of 106 anti-psychotic-treated patients from across the diagnostic spectrum, and investigated changes in glycaemic status. Between baseline and follow-up assessment (mean follow-up time, 599.3 [SD ± 235.4] days glycaemic status was unchanged in 78 (86.7%) patients; 5 (5.6%) reverted from impaired fasting glucose (IFG) to normoglycaemia in the absence of any pharmacological or lifestyle intervention and all were taking a `high risk' drug (clozapine or olanzapine). These preliminary data suggest that progression to overt diabetes mellitus is not inevitable in patients who develop IFG during anti-psychotic treatment. Switching to another agent simply on the basis of the development of IFG may not offer any advantage, especially if the mental state is stable.

Key Words: anti-psychotics • diabetes • impaired fasting glucose • schizophrenia • bipolar disorder • body mass index

This version was published on July 1, 2008

Journal of Psychopharmacology, Vol. 22, No. 5, 563-566 (2008)
DOI: 10.1177/0269881107081532
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