Sernyak Michael J, Leslie Douglas L, Alarcon Renato D, Losonczy Miklos F, Rosenheck Robert
Psychiatry Service, VA Connecticut Healthcare System, West Haven, 06516, USA.
Am J Psychiatry. 2002 Apr;159(4):561-6. doi: 10.1176/appi.ajp.159.4.561.
The development of both type I and type II diabetes after initiation of some atypical neuroleptics has been reported, primarily in studies involving small series of patients. This study used administrative data from a large national sample of patients with a diagnosis of schizophrenia to compare the prevalence of diabetes mellitus in patients receiving prescriptions for atypical and typical neuroleptics.
All outpatients with schizophrenia treated with typical and atypical neuroleptics over 4 months in 1999 in the Veterans Health Administration of the Department of Veterans Affairs (VA) were included in this study. Patients treated with atypical neuroleptics were those who received prescriptions for clozapine, olanzapine, risperidone, or quetiapine. Patients with a diagnosis of diabetes were also identified by using ICD-9 codes in VA administrative databases. The prevalence of diabetes mellitus across age groups and among patients receiving prescriptions for different atypical neuroleptics was examined with multiple logistic regression.
A total of 38,632 patients were included in the study: 15,984 (41.4%) received typical neuroleptics and 22,648 (58.6%) received any atypical neuroleptic (1,207 [5.3%] received clozapine; 10,970 [48.4%], olanzapine; 955 [4.2%], quetiapine; and 9,903 [43.7%], risperidone; 387 patients received prescriptions for more than one atypical neuroleptic). When the effects of age were controlled, patients who received atypical neuroleptics were 9% more likely to have diabetes than those who received typical neuroleptics, and the prevalence of diabetes was significantly increased for patients who received clozapine, olanzapine, and quetiapine, but not risperidone. However, for patients less than 40 years old, all of the atypical neuroleptics were associated with a significantly increased prevalence of diabetes.
In this large group of patients with schizophrenia, receipt of a prescription for atypical neuroleptics was significantly associated with diabetes mellitus.
已有报道称，在开始使用某些非典型抗精神病药物后，I型和II型糖尿病均有发生，主要是在涉及少量患者的研究中。本研究使用来自全国大量精神分裂症患者样本的管理数据，比较接受非典型和典型抗精神病药物处方的患者中糖尿病的患病率。
本研究纳入了1999年在退伍军人事务部（VA）退伍军人健康管理局接受典型和非典型抗精神病药物治疗超过4个月的所有精神分裂症门诊患者。接受非典型抗精神病药物治疗的患者是那些接受氯氮平、奥氮平、利培酮或喹硫平处方的患者。通过VA管理数据库中的ICD - 9编码识别出患有糖尿病的患者。使用多元逻辑回归分析不同年龄组以及接受不同非典型抗精神病药物处方的患者中糖尿病的患病率。
共有38632名患者纳入研究：15984名（41.4%）接受典型抗精神病药物治疗，22648名（58.6%）接受任何一种非典型抗精神病药物治疗（1207名[5.3%]接受氯氮平；10970名[48.4%]，奥氮平；955名[4.2%]，喹硫平；9903名[43.7%]，利培酮；387名患者接受了不止一种非典型抗精神病药物的处方）。在控制年龄影响后，接受非典型抗精神病药物治疗的患者患糖尿病的可能性比接受典型抗精神病药物治疗的患者高9%，接受氯氮平、奥氮平和喹硫平治疗的患者糖尿病患病率显著增加，但利培酮治疗的患者未出现这种情况。然而，对于年龄小于40岁的患者，所有非典型抗精神病药物都与糖尿病患病率显著增加相关。
在这一大群精神分裂症患者中，接受非典型抗精神病药物处方与糖尿病显著相关。
