title: Diabetic ketoacidosis among patients receiving clozapine: a case series and review of socio-demographic risk factors.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) has been associated with clozapine. The purpose of this study is to examine the clinical-demographic correlates of DKA among outpatients receiving clozapine.
  
  
  METHODS
  A literature search was conducted from 1966 to present using Medline to identify 23 case reports of clozapine-associated DKA. In addition, a cohort of twenty-six patients with clozapine-associated diabetes at the University of Rochester Medical Center Department of Psychiatry were examined for histories of DKA through review of medical records. Based on a total sample of 26 case reports including three unpublished cases at University of Rochester, associations between clinical and demographic variables and DKA were examined.
  
  
  RESULTS
  African American patients were significantly more likely than other patients to have DKA (p < 0.0001). Clozapine treatment duration was significantly shorter among patients with DKA than those without DKA (p < 0.0001), with 61.5% of patients developing DKA within three months of clozapine initiation. Also, presence of antidiabetic medications was negatively correlated with DKA (p < 0.0001). Trends were noted toward an association between low doses of clozapine (p < 0.0583) and toward a negative association between family history of diabetes (p < 0.0696).
  
  
  CONCLUSIONS
  Clozapine is associated with DKA that usually presents in patients who have not previously been diagnosed with diabetes. DKA typically occurs early in the course of treatment, when clozapine treatment duration is short and doses are low.
authors.affiliation: Central New York Psychiatric Center, Marcy, New York, USA. niknihal@gmail.com
authors.forename: Nikhil D
authors.initials: ND
authors.lastname: Nihalani
authors.forename: Xin
authors.initials: X
authors.lastname: Tu
authors.forename: J Steven
authors.initials: JS
authors.lastname: Lamberti
authors.forename: David
authors.initials: D
authors.lastname: Olson
authors.forename: Telva
authors.initials: T
authors.lastname: Olivares
authors.forename: G Oana
authors.initials: GO
authors.lastname: Costea
authors.forename: Wan
authors.initials: W
authors.lastname: Tang
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D044383:Black People / Q000523:psychology; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D016883:Diabetic Ketoacidosis / Q000139:chemically induced* / Q000175:diagnosis / Q000208:ethnology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D013223:Statistics as Topic; D044465:White People / Q000523:psychology; D001741:Black or African American
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine