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CMAJ • March 18, 2003; 168 (6)
© 2003 Canadian Medical Association or its licensors

Letters
Correspondance

Antipsychotic drugs and diabetes

Roger S. McIntyre

Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ont.

I read with interest Eric Wooltorton's article about trials of risperidone involving patients with dementia1 and would like to clarify an important point. In the article, Wooltorton stated that "Risperidone . . . appears to cause diabetes." The cause of diabetes mellitus is in fact unknown. Rather, this condition is a multifactorial phenotype, and it is unlikely that any single factor will be sufficient to explain the illness in most populations. An article of which I was a coauthor2 was inappropriately cited as a reference for the suggestion that risperidone causes diabetes mellitus; however, the cited article does not make such a statement.

It is emerging that several of the novel antipsychotics are associated with weight gain. Not only is this effect disquieting for patients, but it may also increase the risk of obesity-related morbidity. Furthermore, some predisposed patients receiving antipsychotic medications may have de novo glucose dysregulation, exacerbation of pre-existing diabetes mellitus or the induction of diabetic ketoacidosis. Although the risk associated with each of the commercially available novel antipsychotics is not definitively known, there have been significantly more cases of these problems with clozapine and olanzapine.3,4,5 However, that being said, it remains inaccurate to say that either of these drugs "causes" diabetes.

Roger S. McIntyre Assistant Professor Department of Psychiatry University of Toronto Toronto, Ont.

Footnotes

Competing interests: Dr. McIntyre is a paid consultant to Eli Lilly, Janssen, AstraZeneca, Wyeth, and Organon. He has received speaker fees from Eli Lilly, Jannsen Ortho, AstraZeneca, GlaxoSmithKline, Lundbeck, Wyeth, Organon, and ORYX Pharmaceuticals.


References

  1. Wooltorton E. Risperidone (Risperdal): increased rate of cerebrovascular events in dementia trials. CMAJ 2002;167(11):1269-70.[Free Full Text]
  2. McIntyre RS, McCann SM, Kennedy SH. Antipsychotic metabolic effects: weight gain, diabetes mellitus and lipid abnormalities. Can J Psychiatry 2001;46(3):273-81.[Medline]
  3. Gianfrancesco FD, Grogg AL, Mahmoud RA, Wang RH, Nasrallah HA. Differential effects of risperidone, olanzapine, clozapine, and conventional antipsychotics on type 2 diabetes: findings from a large health plan database. J Clin Psychiatry 2002;63:920-30.[Medline]
  4. Koro CE, Fedder DO, L'Italien GJ, Weiss SS, Magder LS, Kreyenbuhl J, et al. Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case–control study. BMJ [Internet] 2002;325:243. Available: bmj.com/current.shtml#PAPERS (accessed 2003 Feb 25).
  5. Koller EA, Doraiswamy PM. Olanzapine-associated diabetes mellitus. Pharmacotherapy 2002; 22: 841-52.[Medline]




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