Nanasawa Hideki, Sako Akahito, Mitsutsuka Tomohiko, Nonogaki Kaori, Kondo Tadayuki, Mishima Shuichi, Uju Yoriyasu, Ito Toshihiko, Enomoto Tetsuro, Hayakawa Tatsuro, Yanai Hidekatsu
Department of Internal Medicine Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan.
Medicine (Baltimore). 2017 Jan;96(3):e5900. doi: 10.1097/MD.0000000000005900.
We aimed to describe the characteristics and clinical course of patients who developed diabetes associated with the use of quetiapine.This study included patients who received quetiapine for over a month between April 2008 and November 2013, and were diagnosed as having new-onset diabetes after initiation of quetiapine. We excluded patients who developed diabetes more than 1 year after discontinuation of quetiapine. We identified new-onset diabetes by hemoglobin A1c or prescriptions of antidiabetic drugs.Among 1688 patients who received quetiapine, hemoglobin A1c had been measured in 595 (35.2%) patients at least once during the observation period, and 33 (2.0%) patients had received hypoglycemic drugs. Eighteen (1.1%) patients were considered to have developed new-onset diabetes associated with quetiapine after a median of 1.6 years following initiation of quetiapine. Median (interquartile range) age was 54.5 (29.8) years, 8 patients were male, and median (interquartile range) duration of mental illness was 15.3 (13.8) years. Median hemoglobin A1c and body mass index (BMI) were 7.1 (1.4) % and 28.4 (7.0) kg/m, respectively. Seventeen patients had dyslipidemia when diabetes was discovered. All of these discontinued quetiapine within 3 months after the diagnosis of diabetes, and the diabetes in 4 patients had ameliorated without hypoglycemic drugs. Of 13 patients who had received either oral hypoglycemic drugs or insulin, 2 patients achieved well-controlled hemoglobin A1c without hypoglycemic drugs, and 10 patients had hemoglobin A1c 5.0% to 7.7% with the continued use of hypoglycemic drugs.We demonstrated that almost all patients who developed quetiapine-associated diabetes had dyslipidemia and increased BMI. There was no life-threatening hyperglycemia and diabetes was ameliorated just by discontinuation of quetiapine in several patients. The monitoring of metabolic parameters during antipsychotic treatment is important to diagnose and treat diabetes earlier.
我们旨在描述使用喹硫平后发生糖尿病的患者的特征及临床病程。本研究纳入了2008年4月至2013年11月期间接受喹硫平治疗超过1个月且在开始使用喹硫平后被诊断为新发糖尿病的患者。我们排除了在停用喹硫平1年多后发生糖尿病的患者。我们通过糖化血红蛋白或抗糖尿病药物处方来确定新发糖尿病。在1688例接受喹硫平治疗的患者中，595例（35.2%）患者在观察期内至少测量了1次糖化血红蛋白，33例（2.0%）患者接受了降糖药物治疗。18例（1.1%）患者在开始使用喹硫平后中位1.6年被认为发生了与喹硫平相关的新发糖尿病。中位（四分位间距）年龄为54.5（29.8）岁，8例为男性，中位（四分位间距）精神疾病病程为15.3（13.8）年。糖化血红蛋白和体重指数（BMI）的中位数分别为7.1（1.4）%和28.4（7.0）kg/m²。17例患者在发现糖尿病时患有血脂异常。所有这些患者在糖尿病诊断后3个月内停用了喹硫平，4例患者的糖尿病在未使用降糖药物的情况下有所改善。在13例接受口服降糖药物或胰岛素治疗的患者中，2例患者在未使用降糖药物的情况下糖化血红蛋白得到良好控制，10例患者在继续使用降糖药物的情况下糖化血红蛋白为5.0%至7.7%。我们证明，几乎所有发生喹硫平相关性糖尿病的患者都有血脂异常和BMI升高。没有危及生命的高血糖情况，并且有几名患者仅通过停用喹硫平糖尿病就得到了改善。在抗精神病药物治疗期间监测代谢参数对于早期诊断和治疗糖尿病很重要。
