Association between antipsychotic drugs and diabetes

Abstract

The link between atypical antipsychotic drugs and the development of diabetes has been hotly debated in the literature. In this review, we attempt to classify the various types of data published and presented in a hierarchical basis. Case reports and retrospective pharmacoepidemiological studies suggest that both conventional and atypical antipsychotic medications are associated with an increased risk of glucose abnormalities or diabetes. Prospective data examining the relationship between atypical antipsychotic drugs and diabetes began to emerge in 2003 and are much less conclusive. Estimates of the attributable risk associated with atypical antipsychotic drugs are low. The few studies that have included a placebo group suggest that we cannot necessarily blame antipsychotic medication when diabetes develops in an individual with schizophrenia.

Antipsychotic drugs and diabetes—an application of the Austin Bradford Hill criteria

“…Much of the increased risk can be ascribed to traditional diabetic risk factors such as family history, physical inactivity and poor diet, while there is evidence that SMI itself also increases the risk of diabetes [5][6][7][8]. Any data concerning the link between antipsychotics and diabetes must therefore give due consideration to other potentially confounding factors [2].…”

“…Pharmaco-epidemiological studies mainly rely on the analysis of computerised databases of patients treated in various organisations and are limited by the quality of clinical data recorded. Many recognised risk factors for diabetes are not always recorded in the databases, and thus most studies are not controlled for age, race, diet, physical activity, family history or polypharmacy [2].…”

“…In this paper we will examine the nine Austin Bradford Hill criteria to gain a further understanding about the association between antipsychotic drugs and diabetes, according to the proposal of Shakir and Layton [13]. The review will not set out in detail all of the evidence which has been reviewed by us previously [1,2], but where novel data have been published we will draw attention to them. We hope that we will enable evidencebased prescribing of second-generation antipsychotic drugs and demonstrate the utility of the Bradford Hill criteria when considering drug side effects.…”

“…Some of these studies compare psychiatric patients receiving antipsychotic drugs with the general population and therefore may overestimate the risk attributable to the drug because the general population is an inappropriate control group. The rates of diabetes are increased in schizophrenic populations and therefore there may be alternative explanations for the increased risk [2]. It Increasing exposure is associated with increasing risks of disease…”

“…While it is likely that there are multiple mechanisms, some of the newer second-generation antipsychotic drugs have been singled out as the major cause of the diabetes in this patient group [2].…”