Diabetic ketoacidosis in patients exposed to antipsychotics: a systematic literature review and analysis of Danish adverse drug event reports

Abstract

Increased awareness of the potential risk of antipsychotic-associated DKA and subsequent T1DM diagnosis, with insulin requirements for glycemic control, is warranted. The underlying mechanisms are poorly understood but most probably multifactorial. Certainly, further studies are warranted. Clinicians must utilize appropriate monitoring in susceptible patients and consider the possibility of continuing antipsychotic treatment with appropriate diabetic care.

Diabetic ketoacidosis and diabetes associated with antipsychotic exposure among a previously diabetes-naive population with schizophrenia: a nationwide nested case–control study

“…Most antipsychotics were at risk of causing DKA but due to the limited number of cases ORs for individual antipsychotics could not be estimated. However, cases exposed to high-risk metabolic antipsychotics, including clozapine and olanzapine, relative to those of low risk, including aripiprazole, ziprasidone and high-potency FGAs, had an increased incidence of DKA, thus corroborating the findings of previous studies [7,26,27] and reviews [28][29][30][31]. However, confounding by indication could underestimate the risk of DKA associated with highrisk metabolic antipsychotics, as physicians may be less likely to prescribe them to someone with known risk factors (see above).…”

“…In addition, only a few cases have been previously reported regarding DKA associated with FGAs [29]. That the low-risk metabolic antipsychotic aripiprazole may cause DKA further fuels the argument of more acute effects of antipsychotics on beta cell function [28,29]. Although aripiprazole is less likely to cause weight gain and glucose dysregulation [20], confounding by indication cannot be ruled out, as those at high risk tend to have aripiprazole prescribed for safety reasons [36].…”

Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review

“…Although no relevant clinical studies are available, diabetic ketoacidosis is frequently reported in case reports of patients taking antipsychotics, in particular OLA, CLO, and RIS 200,201…”

Risk of diabetes and dyslipidemia during clozapine and other antipsychotic drug treatment of schizophrenia in Iceland

“…Patients treated with antipsychotics have an estimated 10 times the risk of developing ketoacidosis compared to the normal population (12). Increased risk of ketoacidosis during clozapine treatment has been documented in case reports (13).…”