High Rates of Undiagnosed Diabetes, Hypertension Plague Those Taking Antipsychotics

Posted Sep 22, 2008.By Michele G. Sullivan

BARCELONA (EGMN) - More than 20% of patients taking antipsychotic medications for schizophrenia were at risk for diabetes, more than 30% had undiagnosed hyperlipidemia, and more than 50% had undiagnosed hypertension, a large European epidemiologic study has found.

The findings drive home the need for continuous monitoring of patients taking these drugs, Dr. Marc de Hert and his colleagues wrote in a poster presented at the annual congress of the European College of Neuropsychopharmacology.

"There is clearly a need for more effective physician education to ensure that blood glucose is measured systematically in patients with schizophrenia for whom antipsychotic drug treatment is envisaged, as recommended in the American Diabetes Association guidelines," wrote Dr. de Hert of the Catholic University Louvain (Belgium). "The results emphasize the need for careful follow-up of these patients, to detect the occurrence of metabolic disorders."

The observational study was launched in 2006; it included 2,270 patients with schizophrenia recruited in 12 European countries. Patients made a single clinic visit, during which they underwent a metabolic workup that included measurement of fasting blood glucose, weight, waist, hips, and blood pressure.

The patients' median age was 41; 55% were male. Most (76%) had paranoid schizophrenia; the median duration of illness was 11 years.

The most frequently used typical antipsychotics were haloperidol (48%) and zuclopenthixol (20%). The most frequently used atypicals were risperidone (25%), olanzapine (23%), clozapine (19%), amisulpride (17%), and quetiapine (12%).

Only 4% of the patients had a diagnosis of diabetes, yet an additional 24% either had or were at risk of the disorder, the investigators wrote. Of these 559 patients, 75 had a fasting blood glucose of at least 126 mg/dL, consistent with diabetes, and 484 presented with an impaired fasting glucose of 100-126 mg/dL.

Seven percent (161) previously had been diagnosed with hyperlipidemia. However, an additional 54% of the cohort had undiagnosed hyperlipidemia at the time of the exam.

Hypertension previously had been diagnosed in 248 patients. But at the study visit, an additional 738 patients (32%) had elevated blood pressures; elevations were significantly more likely in those taking a typical than an atypical antipsychotic.

About two-thirds of the cohort, both men and women, were overweight, with a body mass index of more than 25 kg/m²; 25% of both groups were obese. About 50% of the entire cohort showed abdominal obesity.

Women taking an atypical antipsychotic were significantly more likely to be overweight or obese, and to have higher waist and hip circumference, than women taking a typical antipsychotic. There were no relationships between drug class and weight among the men.

Weight gain in the prior year occurred in 37% of those taking a typical antipsychotic and in 49% of those taking an atypical. Those taking an atypical were significantly more likely than those taking a typical to report a weight gain of more than 5 kg in that period.

The incidence of metabolic syndrome was similar in both groups (37%).

This study was sponsored and funded by Sanofi-Aventis.