title: Risk of New-Onset Diabetes After Long-Term Treatment With Clozapine in Comparison to Other Antipsychotics in Patients With Schizophrenia.
abstract: It has been suggested that clozapine has one of the largest diabetic effects of all atypical antipsychotics. To confirm these findings, we examined retrospectively the risk of new-onset diabetes in long-term clozapine treatment compared to treatment with other antipsychotics in a matched control population with schizophrenia or schizoaffective disorder. Ninety-four adult patients with schizophrenia or schizoaffective disorder who had been treated with clozapine for 5 years or longer were matched on age, diagnosis, and sex to 94 patients without any use of clozapine. The groups were followed up for as long as 20 years. The cumulative incidence of new detection of diabetes in the clozapine group was 22.3% (mean follow-up, 12.3 years; absolute risk difference, 6.3%; 95% confidence interval, -4.9% to 17.5%). An additional rigorous analysis of the 83 matched pairs with normal glucose measurement before end point showed a significant risk difference between the 2 groups (21.7% compared with 8.4%) but may have been biased against clozapine. We conclude that definitive evidence showing a clinically significant larger risk for new-onset diabetes after long-term treatment with clozapine in comparison to other antipsychotics is lacking.
authors.affiliation: From the *Department of Specialised Treatments, Mental Health Services North-Holland-North, Alkmaar; †Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht; ‡Medical Centre Alkmaar; §Hospital Pharmacy Medical Centre Alkmaar, Alkmaar; and ∥Department of Community Psychiatry, Mental Health Services North-Holland-North, Heerhugowaard, the Netherlands.
authors.forename: Peter F J
authors.initials: PF
authors.lastname: Schulte
authors.forename: Johanna T H
authors.initials: JT
authors.lastname: Bocxe
authors.forename: Hieronymus J
authors.initials: HJ
authors.lastname: Doodeman
authors.forename: Ingrid M M
authors.initials: IM
authors.lastname: van Haelst
authors.forename: Dan
authors.initials: D
authors.lastname: Cohen
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003024:Clozapine / Q000009:adverse effects*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine