van Winkel Ruud, De Hert Marc, Wampers Martien, Van Eyck Dominique, Hanssens Linda, Scheen Andre, Peuskens Joseph
University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium.
J Clin Psychiatry. 2008 Mar;69(3):472-9. doi: 10.4088/jcp.v69n0320.
To investigate 3-month changes in glucose metabolism in a naturalistic sample of patients with schizophrenia newly started on or switched to specific atypical antipsychotic medication therapy.
One hundred eighty-three patients were evaluated before initiation and 3 months after with a 75-g glucose load oral glucose tolerance test (OGTT). Data were collected between November 2003 and January 2007.
Eight patients (4.4%) developed new-onset diabetes within 3 months. Initiation of clozapine resulted in a significantly higher risk for new-onset glucose abnormalities than initiation of aripiprazole (odds ratio = 67.29, 95% CI = 5.23 to 866.49). Significant drug x time interactions were found for all OGTT glucose assessments (fasting: F = 6.79, df = 5,177; p < .0001; 30 minutes: F = 3.89, df = 5,177; p = .0023; 60 minutes: F = 5.03, df = 5,177; p = .0002; 120 minutes: F = 3.78, df = 5,177; p = .0028), with the evolution of plasma glucose levels being significantly worse in patients initiated on clozapine therapy (fasting, 30 minutes, and 60 minutes), olanzapine therapy (fasting, 60 minutes, and 120 minutes), and quetiapine therapy (fasting and 60 minutes) than in patients initiated on aripiprazole therapy (p < .05). Clozapine was also significantly more deleterious than risperidone and amisulpride for fasting plasma glucose level changes (p < .05). Type of initiation (start or switch) did not affect any of the metabolic parameters.
The incidence of new-onset glucose abnormalities, including diabetes, in the first 3 months after newly starting or switching atypical antipsychotic medication is high and may be markedly influenced by type of prescribed antipsychotic. The importance of accurately screening for new-onset glucose abnormalities after initiation of an atypical antipsychotic is emphasized.
在新开始使用或换用特定非典型抗精神病药物治疗的精神分裂症患者自然样本中，研究3个月内葡萄糖代谢的变化。
183例患者在开始治疗前及治疗3个月后接受75克葡萄糖负荷口服葡萄糖耐量试验（OGTT）评估。数据收集于2003年11月至2007年1月之间。
8例患者（4.4%）在3个月内出现新发糖尿病。与开始使用阿立哌唑相比，开始使用氯氮平导致新发葡萄糖异常的风险显著更高（比值比=67.29，95%可信区间=5.23至866.49）。在所有OGTT葡萄糖评估中均发现显著的药物×时间交互作用（空腹：F=6.79，自由度=5,177；p<.0001；30分钟：F=3.89，自由度=5,177；p=.0023；60分钟：F=5.03，自由度=5,177；p=.0002；120分钟：F=3.78，自由度=5,177；p=.0028），开始使用氯氮平治疗的患者（空腹、30分钟和60分钟）、奥氮平治疗的患者（空腹、60分钟和120分钟）以及喹硫平治疗的患者（空腹和60分钟）血浆葡萄糖水平的变化明显比开始使用阿立哌唑治疗的患者更差（p<.05）。氯氮平对空腹血糖水平变化的危害也明显大于利培酮和氨磺必利（p<.05）。开始治疗的类型（开始或换用）不影响任何代谢参数。
新开始或换用非典型抗精神病药物后的前3个月内，包括糖尿病在内的新发葡萄糖异常的发生率很高，且可能受到所开抗精神病药物类型的显著影响。强调了在开始使用非典型抗精神病药物后准确筛查新发葡萄糖异常的重要性。
