Conventional Antipsychotic Agents Diabetes and Glucose Intolerance

Conventional antipsychotic agents, which have primarily antidopaminer-gic activity, may alter glucose-insulin homeostasis (Hagg et al. 1998). In particular, the low-potency phenothiazines may induce diabetes mellitus or aggravate existing diabetes mellitus (Hagg et al. 1998; Haupt and Newcomer 2001). Because of this finding, chlorpromazine has been used to prevent hypoglycemia in patients with malignant insulinoma. Furthermore, chlorpromazine has been shown to induce hyperglycemia in healthy volunteers as well as in patients with latent diabetes (Hagg et al. 1998).

Other conventional antipsychotic agents, such as the higher-potency agent haloperidol, are associated with a decrease in the prevalence rate of diabetes in the schizophrenia population. For example, Mukheijee et al. (1996) found an overall diabetes prevalence rate of 15% in 95 patients with schizophrenia. In patients younger than 50 years, there were no cases of diabetes mellitus. For patients ages 50 to 59 years, however, the prevalence rate was 12.9%, and for patients ages 60 to 69 years the prevalence rate was 18.9%. Finally, for those ages 70 to 74 years the prevalence rate was 16.7%. Controlling for age, gender, and cumulative duration of anti-psychotic treatment, medication-free patients were more likely to develop diabetes mellitus than those receiving treatment with conventional agents (Mukher-jee et al. 1996). Notably, the prevalence rates quoted in Mukherjee's study exceeded those expected for type II diabetes mellitus in the general population, lending further evidence to the argument that schizophrenia may indeed be an independent risk factor for the development of diabetes mel-litus (Henderson 2001b).

In summary, examination of reports discussing the prevalence rates of diabetes mellitus or impaired glucose tolerance in schizophrenic patients shows that among the conventional antipsychotic agents, the effects of glucose regulation may vary in magnitude across individual agents. Specifically, the phenothiazines may increase a patient's susceptibility to developing diabetes mellitus, but there is no significant association between diabetes mellitus and the use of other conventional antipsychotic medications.

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