Disturbed glucose metabolism among patients taking olanzapine and typical antipsychotics.
Concern about the potentially diabetogenic effect of antipsychotics has existed since the introduction of chlorpromazine in the 1950s. However, there is controversy as to whether the newer "atypical" antipsychotics are more diabetogenic than older "typical" agents. We undertook a retrospective cohort analysis of 484 patients receiving outpatient prescriptions for either olanzapine (n=312) or one of four typical antipsychotics (n=172) at the Atlanta Veterans Affairs Medical Center from October 1, 1996 (when olanzapine first became available at our institution) through December 31, 2000. The four typical antipsychotics were haloperidol, fluphenazine, chlorpromazine, and perphenazine.Random plasma glucose values collected over the 4.25-year period were classified as to whether they had been drawn before, during, or after exposure to an antipsychotic. Primary outcome measures were the development of a random plasma glucose > or =160 mg/dl or > or 200 mg/dl while on an antipsychotic. Significant differences were found in the percentages of antipsychotic-treated patients developing a random plasma glucose > or =160 mg/dl (olanzapine 12.5% versus typical antipsychotics 5.2%, P<.01, adjusted odds ratio 3.6) and > or =200 mg/dl (olanzapine 5.4% versus typical antipsychotics 1.7%, P=.02, adjusted odds ratio 5.1). For patients younger than 60 years of age, 10.5% of those taking olanzapine developed a random plasma glucose > or =160 mg/dl compared with 0% of those taking typical antipsychotics, P=.0003. In conclusion, we found that among individuals without a plasma glucose value > or =160 mg/dl at baseline, use of olanzapine was associated with an increased risk of elevation in plasma glucose compared with use of typical antipsychotics.
Dunlop
Boadie W
BW
Mood and Anxiety Disorders Program, Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30329, USA. bdunlop@emory.edu
Sternberg
Maya
M
Phillips
Lawrence S
LS
Andersen
Judy
J
Duncan
Erica
E
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use; D002746:Chlorpromazine / Q000009:adverse effects; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000097:blood* / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D005476:Fluphenazine / Q000009:adverse effects; D005947:Glucose / Q000378:metabolism*; D006220:Haloperidol / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010546:Perphenazine / Q000009:adverse effects; D012189:Retrospective Studies
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010546:Perphenazine; D005947:Glucose; D006220:Haloperidol; D000077152:Olanzapine; D005476:Fluphenazine; D002746:Chlorpromazine