Association between atypical antipsychotic agents and type 2 diabetes: review of prospective clinical data

Background Most evidence suggesting an association between schizophrenia, antipsychotic medications and diabetes has been based on retrospective studies not controlled for important confounders. Aims To compare diabetogenic risk between antipsychotic medications; and to describe the limitations of current prospective data-sets. Method Systematic review of prospective clinical data. Results No difference in the incidence of glycaemic abnormalities between placebo cohorts and antipsychotic medication cohorts was identified. No significant difference between any of the antipsychotic medications studied in terms of their association with glycaemic abnormalities was identified. Treatment related weight gain did not appear to increase the risk of developing diabetes. Conclusions Diabetogenic potential ascribed to atypical antipsychotic drugs, resulting from retrospective studies, may be incorrect. Cohort sizes and incomplete sampling must preclude any definitive conclusions. Long-term, large, comparative prospective trials are needed, along with agreement upon glucose measurement of choice. Declaration of interest C.B. is employed by Eli Lilly & Co. Ltd. B.L. has been consultant to Eli Lilly & Co. in regard to diabetes and schizophrenia.