Gianfrancesco Frank, White Richard, Wang Ruey-hua, Nasrallah Henry A
HECON Associates, 9833 Whetstone Drive, Montgomery Village, MD 20886, USA.
J Clin Psychopharmacol. 2003 Aug;23(4):328-35. doi: 10.1097/01.jcp.0000085404.08426.3a.
Case evidence suggests that some of the atypical antipsychotics may induce type 2 diabetes. The objective of this study was to evaluate the association of antipsychotic treatment with type 2 diabetes in a large health plan database. Claims data for patients with psychosis within a health plan of nearly 2 million members were analyzed using logistic regression. Frequencies of newly treated type 2 diabetes in patients untreated with antipsychotics and among patients treated with quetiapine, risperidone, olanzapine, and conventional antipsychotics were compared. Based on exposure measured in months of antipsychotic treatment, quetiapine and risperidone patients had estimated odds of receiving treatment for type 2 diabetes that were lower than those of patients untreated with antipsychotics (not statistically significant); patients treated with conventional antipsychotics had estimated odds that were virtually equivalent to those of patients untreated with antipsychotics; olanzapine alone had odds that were significantly greater than those of patients untreated with antipsychotics (P = 0.0247). Odds ratios based on 8 months of screening for pre-existing type 2 diabetes and assuming 12 months of antipsychotic treatment were: risperidone = 0.660 (95% CI 0.311-1.408); olanzapine = 1.426 (95% CI 1.046-1.955); quetiapine = 0.976 (95% CI 0.422-2.271); and conventional antipsychotics = 1.049 (95% CI 0.688-1.613). Case reports, prospective trials, and other retrospective studies have increasingly implicated olanzapine and clozapine as causing or exacerbating type 2 diabetes. Few have implicated risperidone while evidence on quetiapine has been limited. This study supports earlier findings on risperidone versus olanzapine and builds evidence on quetiapine. Additional studies are needed to evaluate the association of antipsychotic treatment with type 2 diabetes.
病例证据表明，某些非典型抗精神病药物可能诱发2型糖尿病。本研究的目的是在一个大型健康计划数据库中评估抗精神病药物治疗与2型糖尿病之间的关联。使用逻辑回归分析了一个拥有近200万成员的健康计划中精神病患者的索赔数据。比较了未使用抗精神病药物治疗的患者以及使用喹硫平、利培酮、奥氮平和传统抗精神病药物治疗的患者中新发2型糖尿病的频率。根据抗精神病药物治疗月数来衡量暴露情况，喹硫平和利培酮治疗的患者接受2型糖尿病治疗的估计比值低于未使用抗精神病药物治疗的患者（无统计学意义）；使用传统抗精神病药物治疗的患者估计比值与未使用抗精神病药物治疗的患者几乎相当；仅使用奥氮平治疗的患者比值显著高于未使用抗精神病药物治疗的患者（P = 0.0247）。基于对已存在的2型糖尿病进行8个月筛查并假设抗精神病药物治疗12个月的比值比为：利培酮 = 0.660（95%可信区间0.311 - 1.408）；奥氮平 = 1.426（95%可信区间1.046 - 1.955）；喹硫平 = 0.976（95%可信区间0.422 - 2.271）；传统抗精神病药物 = 1.049（95%可信区间0.688 - 1.613）。病例报告、前瞻性试验和其他回顾性研究越来越多地表明奥氮平和氯氮平会导致或加重2型糖尿病。很少有研究表明利培酮有此作用，而关于喹硫平的证据有限。本研究支持了之前关于利培酮与奥氮平的研究结果，并为喹硫平提供了证据。需要进一步的研究来评估抗精神病药物治疗与2型糖尿病之间的关联。
