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By Melissa Tennen, HealthAtoZ writer
Certain antipsychotic drugs may increase your risk for diabetes and obesity.
That's the warning from a panel of experts who pored over studies and reports about second-generation antipsychotics (SGAs) and the connection with diabetes and obesity.
"Anyone taking these medications can be at risk for diabetes and obesity," says Eugene J. Barrett, M.D., Ph.D., president of the American Diabetes Association (ADA), professor of internal medicine and pediatrics at University of Virginia Health System in Charlottesville.
While acknowledging the proof is far from ironclad, enough evidence says the hazard may be real. The panel from the ADA, the American Psychiatric Association (APA), the American Association of Clinical Endocrinologists and the North American Association for the Study of Obesity says people and their doctors should definitely be concerned.
"In some studies, when patients who developed diabetes stopped taking the medications, their diabetes went away. But when they went back on them, the diabetes came back," Barrett says. "This all came to light after the drugs were on the market."
The risk for diabetes and obesity might be two times higher among people with mental disorders such as schizophrenia even in the absence of antipsychotic agents. Just how much SGAs add to that is unclear. No study has distinctly made that link, although research is slowly connecting the dots. However, in the last several years the use of SGAs has skyrocketed to treat schizophrenia, bipolar disorder, dementia, autism, personality disorders and other conditions.
There's good reason. As a class of medications, SGAs have fewer and less severe side effects than their predecessors called first generation antipsychotics (FGA), which often cause muscle stiffness, tremor and abnormal movements. SGAs are highly effective, but they are not a cure. Six medications make up the SGAs: clozapine (Clozaril®), risperidone (Risperdal®), olanzapine (Zyprexa®), quetiapine (Seroquel®), ziprasidone (Geodon®) and aripiprazole (Abilify®).
Some people taking SGAs died because their diabetes was not caught in time. Although this is rare, the panel wants doctors to monitor blood sugar levels, blood pressure and weight to help prevent diabetes or treat it as soon as possible.
"The prescribing doctor is in the position to tell the patient about the potential side effects," Barrett says. "We want people to know if they have any the symptoms of diabetes like excessive thirst and excessive urination that they need to see a doctor right away."
May Increase Appetite
But it's not just diabetes that is a potential problem. These medications affect the chemical processes in the brain and in some cases may lead to increased appetite. Without enough physical activity to burn up the extra calories, the weight gain can lead to obesity. By itself, being too heavy is a risk factor for diabetes.
"We know that if you gain weight, your risk of diabetes rises. But these drugs may also alter your sugar metabolism, perhaps requiring your insulin to 'work harder.' This may create an independent and additional risk factor to develop diabetes," says Alan J. Gelenberg, M.D., professor and head of the department of psychiatry at the University of Arizona in Tucson and chairman of the APA's Committee on Research on Psychiatric Treatments.
That means your risk may be higher for diabetes even if you don't have other risk factors, including being older, a family history, inactivity and obesity. Also certain ethnic groups such as African-American and Hispanic have higher risk.
Type 2 diabetes is a chronic condition without a cure. Normally, your body takes the sugar, or glucose, from food and turns it into energy. To do that, the body needs insulin to help open the doors to cells in your tissues, muscles and organs so sugar can enter. In those cells, the sugar is used to keep you alive and give you energy. The pancreas creates just enough insulin to get the job done.
In people with diabetes, something goes wrong. The pancreas still produces insulin, sometimes too much. But the insulin no longer works right. It's almost as if the cells have changed their locks. This is called insulin-resistance, setting the stage for diabetes. Often, people develop a condition called pre-diabetes, which means blood sugar is elevated but not high enough to be diabetes. At this point, diabetes can either be prevented or delayed.
High blood sugar damages blood vessels, but exactly how is not well understood. But too much blood sugar may contribute to atherosclerosis, which is a hardening and narrowing of the arteries. Diabetes may lead to blindness, limb amputations, kidney disease and stroke.
The impact of these drugs on cholesterol is a little less clear. Although there are few studies looking at whether these drugs raise cholesterol, the panel cautions doctors to be aware SGAs might impact these levels.
Risk versus benefits
What is clear is that doctors and patients have to weigh the risks and benefits of taking SGAs, which work well in conditions like schizophrenia. This devastating condition interferes with how a person interprets reality.
"A patient suffering with schizophrenia who has nothing else to take should stay on them," Gelenberg says. "A disease like schizophrenia is much worse than the risk of metabolism disorders."
Barrett suggests people who have to take these medications exercise and eat healthy to help prevent diabetes.
The panel called for more research in its report that appeared in the journal Diabetes Care. Which SGAs carry more risk? Who has a greater risk? The Food and Drug Administration is considering requiring SGA manufacturers to include this warning on labels.
Symptoms of diabetes include:
- Being very thirsty.
- Urinating often.
- Feeling very hungry or tired.
- Having sores that heal slowly.
- Having dry, itchy skin.
- Losing the feeling in your feet or having tingling in your feet.
- Having blurry eyesight.
This article was reviewed and updated June 2007.
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