利培酮、奥氮平、氯氮平及传统抗精神病药物对2型糖尿病的不同影响：来自大型健康计划数据库的研究结果

Differential effects of risperidone, olanzapine, clozapine, and conventional antipsychotics on type 2 diabetes: findings from a large health plan database.

作者信息

Gianfrancesco Frank D, Grogg Amy L, Mahmoud Ramy A, Wang Ruey-hua, Nasrallah Henry A

机构信息

HECON Associates, Montgomery Village, MD 20886, USA.

出版信息

J Clin Psychiatry. 2002 Oct;63(10):920-30. doi: 10.4088/jcp.v63n1010.

DOI:10.4088/jcp.v63n1010

PMID:12416602

Abstract

BACKGROUND

Case series suggest that some antipsychotics may induce or exacerbate type 2 diabetes. This study measured the association of antipsychotic treatments with diabetes at a population level.

METHOD

Claims data for psychosis patients (ICD-CM-9 290.xx-299.xx) within health plans encompassing 2.5 million individuals were analyzed. Patients reporting preexisting type 2 diabetes up to 8 months prior to observation were excluded. The frequency of newly reported type 2 diabetes in untreated patients and among patients treated with antipsychotics from 5 categories (risperidone, olanzapine, clozapine, and high-potency and low-potency conventionals) was compared. Logistic regression models compared the odds of diabetes based on exposure to each of the antipsychotic categories.

RESULTS

Based on 12 months of exposure, the odds of type 2 diabetes for risperidone-treated patients (odds ratio = 0.88, 95% CI = 0.372 to 2.070) was not significantly different from that for untreated patients, whereas patients receiving other antipsychotics had a significantly greater risk of diabetes than untreated patients (p < .05): olanzapine, 3.10 (95% CI = 1.620 to 5.934); clozapine, 7.44 (95% CI = 0.603 to 34.751); high-potency conventionals, 2.13 (95% CI = 1.097 to 4.134); and low-potency conventionals, 3.46 (95% CI = 1.522 to 7.785). Older age and greater use of non-antipsychotic psychotropic medications also contributed to risk of type 2 diabetes. Olanzapine also showed significantly higher (p < .01) odds of diabetes associated with increasing dose.

CONCLUSION

Consistent with previously published literature, these data suggest that olanzapine, clozapine, and some conventional antipsychotics appear to increase the risk of acquiring or exacerbating type 2 diabetes and that the effect may vary by drug. In contrast to these agents, risperidone was not associated with an increased risk of type 2 diabetes.

摘要

背景

病例系列研究表明，某些抗精神病药物可能诱发或加重2型糖尿病。本研究在人群水平上测量了抗精神病药物治疗与糖尿病之间的关联。

方法

分析了涵盖250万人的健康计划中精神病患者（ICD-CM-9 290.xx - 299.xx）的索赔数据。排除在观察前8个月内报告患有2型糖尿病的患者。比较了未治疗患者以及接受5类抗精神病药物（利培酮、奥氮平、氯氮平、高效和低效传统药物）治疗的患者中新报告的2型糖尿病的发生率。逻辑回归模型比较了基于接触每种抗精神病药物类别患糖尿病的几率。

结果

基于12个月的暴露情况，接受利培酮治疗的患者患2型糖尿病的几率（优势比 = 0.88，95%可信区间 = 0.372至2.070）与未治疗患者相比无显著差异，而接受其他抗精神病药物治疗的患者患糖尿病的风险显著高于未治疗患者（p < 0.05）：奥氮平，3.10（95%可信区间 = 1.620至5.934）；氯氮平，7.44（95%可信区间 = 0.6 * 03至34.751）；高效传统药物，2.13（95%可信区间 = 1.097至 / 134）；低效传统药物，3.46（95%可信区间 = 1.522至7.785）。年龄较大以及更多使用非抗精神病精神药物也会增加2型糖尿病的风险。奥氮平还显示随着剂量增加患糖尿病的几率显著更高（p < 0.01）。