Antipsychotics and diabetes

People with chronic psychotic disorders, especially schizophrenia, have an inherently increased risk of developing obesity and diabetes, and are also at increased risk of cardiovascular disease and premature cardiovascular death.

All antipsychotics may contribute to hyperglycaemia and the development of type 2 diabetes, and to a deterioration in the glycaemic profile in patients with pre-existing diabetes. However, the increased risk of developing diabetes and other cardiometabolic abnormalities is not solely attributable to the use of antipsychotics; various factors contribute (including genetic predisposition and environmental and lifestyle factors). All patients taking an antipsychotic should be monitored for the development of diabetes and for other cardiovascular disease risk factors (see management of antipsychotic adverse effects including weight gain and other cardiometabolic effects).

Some antipsychotics are more likely to exacerbate hyperglycaemia or obesity than others (see Approximate relative frequency of common adverse effects of antipsychotics for relative frequencies of adverse effects of antipsychotics). The patient’s psychiatrist should be involved in any decision to change antipsychotics for a patient with serious mental illness. Changing the antipsychotic or its dose can potentially increase the risk of exacerbating psychotic symptoms.

Appropriate management and long-term follow-up must be instigated if hyperglycaemia is detected. See Tests to diagnose diabetes for diagnostic advice and Type 2 diabetes in adults for management advice.