Citrome Leslie L, Jaffe Ari B
New York University School of Medicine, New York, NY and Clinical Research and Evaluation Facility, Nathan S Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
Ann Pharmacother. 2003 Dec;37(12):1849-57. doi: 10.1345/aph.1D142.
To review the pharmacoepidemiologic evidence for the link between exposure to atypical antipsychotics and the development of diabetes mellitus.
A MEDLINE search (1990-March 2003) was conducted.
The search was limited to articles that described findings from analyses of large databases and used the words diabetes or hyperglycemia, and antipsychotic or clozapine or olanzapine or risperidone or quetiapine or ziprasidone or aripiprazole in the title or abstract. The odds ratio or relative risk, together with their corresponding confidence interval, was extracted.
Results are conflicting, and this variability may be due to the different populations studied, different study designs, and the possibility of publication bias related to funding by the pharmaceutical industry. Nevertheless, an increased risk for diabetes mellitus appears to be present for patients receiving atypical antipsychotics. However, differential risk among the atypical antipsychotics is difficult to ascertain.
Clinicians are urged to manage risk by regularly monitoring all patients receiving atypical antipsychotics for the emergence of diabetes mellitus. Future studies should carefully control for confounding variables such as age, diagnosis, change in weight, activity level, family history, and ethnicity.
回顾有关使用非典型抗精神病药物与糖尿病发生之间联系的药物流行病学证据。
进行了MEDLINE检索（1990年至2003年3月）。
检索限于描述大型数据库分析结果的文章，且标题或摘要中使用了糖尿病或高血糖以及抗精神病药物或氯氮平或奥氮平或利培酮或喹硫平或齐拉西酮或阿立哌唑等词。提取比值比或相对危险度及其相应的可信区间。
结果相互矛盾，这种变异性可能归因于所研究的不同人群、不同的研究设计以及与制药行业资助相关的发表偏倚可能性。然而，接受非典型抗精神病药物治疗的患者似乎患糖尿病的风险增加。然而，难以确定不同非典型抗精神病药物之间的风险差异。
敦促临床医生通过定期监测所有接受非典型抗精神病药物治疗的患者是否出现糖尿病来管理风险。未来的研究应仔细控制混杂变量，如年龄、诊断、体重变化、活动水平、家族史和种族。
