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Joint Panel Urges Screening and Monitoring of Patients Using Second- Generation Antipsychotics
The consensus statement, published in the February issue of Diabetes Care, outlines guidelines for doctors treating people with a class of drugs known as second-generation antipsychotics (SGAs). These drugs, the use of which has soared in recent years, are used to treat a variety of mental illnesses, including: schizophrenia spectrum disorders; bipolar disorder; dementia; psychotic depression; autism and developmental disorders; and, to a lesser extent, delirium; aggressive behavior; personality disorders; and posttraumatic stress disorder.
The panel concluded that "there is considerable evidence" that treatment with SGAs can lead to rapid weight gain and that most of the weight gained is fat. Studies also show an association between SGA use and the development of pre-diabetes, diabetes, and elevated blood lipid levels. In some cases, SGA use has also been associated with diabetic ketoacidosis (DKA), which can be life-threatening. While weight gain was associated with first-generation antipsychotics, data regarding other metabolic effects are not available.
The panel also concluded that the SGAs differ in their risk profiles and that some SGAs, such as clozapine and olanzapine, while effective treatment options, raise a greater risk of weight gain, diabetes and lipid disorders than others. The statement notes that "...Even for those medications associated with an increased risk of metabolic side effects, the benefits to specific patients could outweigh the potential risks." Thus, while risks reviewed in this study should influence choice of medication, the need to balance benefits and a wide range of risks underscores the importance of tailoring treatments to individual patients.
Therefore, the panel recommended that doctors prescribing antipsychotic drugs first perform baseline screenings of:
* Personal and family history of obesity, diabetes, dyslipidemia (cholesterol and triglyceride levels), blood pressure or cardiovascular disease;
* Weight and height;
* Waist circumference;
* Blood pressure;
* Fasting plasma glucose; and
* Fasting lipid profile.
The panel also recommended that referral to specialists be considered if problems with significant weight gain, new onset diabetes, or other cardiovascular risk factors occur and that nutrition and physical activity counseling be provided to all patients who are taking antipsychotic medications and are overweight or obese.
The panel recommended frequent follow-up monitoring of any patient receiving SGA therapy, and concluded that people at greatest risk for these complications should be prescribed SGAs least likely to cause them.
The panel concluded that more research is needed to more clearly define the risks associated with SGAs. In the meantime, as with all drugs, the undesirable side effects associated with SGAs should be an important consideration.
Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nation's fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure and non-traumatic amputations. For more information about diabetes, visit the American Diabetes Association Web site www.diabetes.org or call 1-800-DIABETES (1-800-342-2383).
The consensus development conference was supported in part by an educational grant from AstraZeneca, Bristol-Myers Squibb Co., Janssen Pharmaceutical Products, Eli Lilly and Co., and Pfizer Inc.
Source: American Diabetes Association