Differential Effects of Risperidone, Olanzapine, Clozapine, and Conventional Antipsychotics on Type 2 Diabetes: Findings From a Large Health Plan Database
J Clin Psychiatry 2002;63(10):920-930
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Case series suggest that some
antipsychotics may induce or exacerbate type 2 diabetes. This
study measured the association of antipsychotic treatments with
diabetes at a population level.
Method: Claims data for psychosis patients
(ICD-CM-9 290.xx-299.xx) within health plans encompassing 2.5
million individuals were analyzed. Patients reporting preexisting
type 2 diabetes up to 8 months prior to observation were
excluded. The frequency of newly reported type 2 diabetes in
untreated patients and among patients treated with antipsychotics
from 5 categories (risperidone, olanzapine, clozapine, and
high-potency and low-potency conventionals) was compared.
Logistic regression models compared the odds of diabetes based on
exposure to each of the antipsychotic categories.
Results: Based on 12 months of exposure, the
odds of type 2 diabetes for risperidone-treated patients (odds
ratio = 0.88, 95% CI = 0.372 to 2.070) was not significantly
different from that for untreated patients, whereas patients
receiving other antipsychotics had a significantly greater risk
of diabetes than untreated patients (p < .05): olanzapine,
3.10 (95% CI = 1.620 to 5.934); clozapine, 7.44 (95% CI = 0.603
to 34.751); high-potency conventionals, 2.13 (95% CI = 1.097 to
4.134); and low-potency conventionals, 3.46 (95% CI = 1.522 to
7.785). Older age and greater use of non-antipsychotic
psychotropic medications also contributed to risk of type 2
diabetes. Olanzapine also showed significantly higher (p <
.01) odds of diabetes associated with increasing dose.
Conclusion: Consistent with previously published
literature, these data suggest that olanzapine, clozapine, and
some conventional antipsychotics appear to increase the risk of
acquiring or exacerbating type 2 diabetes and that the effect may
vary by drug. In contrast to these agents, risperidone was not
associated with an increased risk of type 2 diabetes.