THE INCREASED RISK OF RANDOM BLOOD GLUCOSE, BODY MASS INDEX AND ABDOMINAL CIRCUMFERENCE IN THE SCHIZOPHRENIC PATIENTS USING CLOZAPINE AND QUETIAPINE
Main
Lailatul Hidayah*
Endang Darmawan
Santi Yuliani
The use of atypical antipsychotics often causes an increase in blood glucose levels, body mass index (BMI) and abdominal circumference. This study aims to identify the increased risk of random blood glucose, BMI and abdominal circumference in the schizophrenic patients using clozapine and quetiapine. This cohort study involved 35 schizophrenic patients (19 patients used clozapine and 16 patients used quetiapine). The measurement of random blood glucose BMI and abdominal circumference was done in the zero month, the first month and the second month. The average of random blood glucose, BMI and abdominal circumference were analyzed using Wilcoxon and Chi-square. In the use of clozapine, there is a significant increase in the average of random blood glucose between the first month and the second month (p=0.1) with the difference of 6.37 mg/dl, there is an increase average in BMI between the first month and the second month (p=0.03) with the difference of 0.18 kg/m² and an average increase in abdominal circumference between the zero month and the first month (p=0.04) with the difference of 1.47 cm, between the first month and the second month (p=0.02) with the difference of 1.94 cm. In the use of quetiapine, a significant increase in abdominal circumference between the first month and the second month (p=0.02) with the difference 1.38 cm. The use of clozapine has more risk in increasing random blood glucose (OR 2.00: CI 95% 0.41-9.76), BMI (OR 2.78: CI 95% 0.69-11.10) and abdominal circumference (OR 3.61: CI 95% 0.89-14.64) compared to the use of quetiapine. The use of clozapine has more risk in increasing blood glucose, BMI and abdominal circumference compared to the use of quetiapine.
ADA. (2017). Diagnosis. American Diabetes Association. https://www.diabetes.org/a1c/diagnosis
Akhtar, S., Kelly, C., Gallagher, A., & Petrie, J. R. (2004). Newer antipsychotic agents, carbohydrate metabolism and cardiovascular risk. The British Journal of Diabetes & Vascular Disease, 4(5), 303–309.
Barbosa, W. B., de Oliveira Costa, J., de Lemos, L. L. P., Gomes, R. M., de Oliveira, H. N., Ruas, C. M., de Assis Acurcio, F., Barbui, C., Bennie, M., & Godman, B. (2018). Costs in the treatment of schizophrenia in adults receiving atypical antipsychotics: an 11-year cohort in Brazil. Applied Health Economics and Health Policy, 16(5), 697–709.
Buse, J. B., Cavazzoni, P., Hornbuckle, K., Hutchins, D., Breier, A., & Jovanovic, L. (2003). A retrospective cohort study of diabetes mellitus and antipsychotic treatment in the United States. Journal of Clinical Epidemiology, 56(2), 164–170.
C Sullivan, L., P Clarke, W., & A Berg, K. (2015). Atypical antipsychotics and inverse agonism at 5-HT2 receptors. Current Pharmaceutical Design, 21(26), 3732–3738.
Chen, P.-Y., Chen, C.-H., Chang, C.-K., Kao, C.-F., Lu, M.-L., Lin, S.-K., Huang, M.-C., Hwang, L.-L., & Mondelli, V. (2018). Orexin-A Levels in Relation to the Risk of Metabolic Syndrome in Patients with Schizophrenia Taking Antipsychotics. International Journal of Neuropsychopharmacology, 1–9. https://doi.org/10.1093/ijnp/pyy075
Chen, V. C.-H., Chen, C.-H., Chiu, Y.-H., Lin, T.-Y., Li, F.-C., & Lu, M.-L. (2018). Leptin/Adiponectin ratio as a potential biomarker for metabolic syndrome in patients with schizophrenia. Psychoneuroendocrinology, 92, 34–40.
Citrome, L., McEvoy, J. P., Todtenkopf, M. S., McDonnell, D., & Weiden, P. J. (2019). A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future. Neuropsychiatric Disease and Treatment, 15, 2559.
de Azua, I. R., Gautam, D., Guettier, J.-M., & Wess, J. (2011). Novel insights into the function of β-cell M3 muscarinic acetylcholine receptors: therapeutic implications. Trends in Endocrinology & Metabolism, 22(2), 74–80.
European Health Risk Monitoring. (2002). Health risk monitoring standar. https://ec.europa.eu/health/ph_projects/1999/monitoring/fp_monitoring_1999_frep_06_en.pdf
Fedorowicz, V. J., & Fombonne, E. (2005). Metabolic side effects of atypical antipsychotics in children: a literature review. Journal of Psychopharmacology, 19(5), 533–550.
Fraguas, D., Correll, C. U., Merchán-Naranjo, J., Rapado-Castro, M., Parellada, M., Moreno, C., & Arango, C. (2011). Efficacy and safety of second-generation antipsychotics in children and adolescents with psychotic and bipolar spectrum disorders: comprehensive review of prospective head-to-head and placebo-controlled comparisons. European Neuropsychopharmacology, 21(8), 621–645.
Gadzik, J. (2006). “ How much should I weigh?”--Quetelet’s equation, upper weight limits, and BMI prime. Connecticut Medicine, 70(2), 81–88.
Grover, S., Hazari, N., Chakrabarti, S., & Avasthi, A. (2016). Metabolic disturbances, side effect profile and effectiveness of clozapine in adolescents. Indian Journal of Psychological Medicine. https://doi.org/10.4103/0253-7176.183091
Gurevich, A., Guller, V., Berner, Y. N., & Tal, S. (2012). Are atypical antipsychotics safer than typical antipsychotics for treating behavioral and psychological symptoms of dementia? The Journal of Nutrition, Health & Aging, 16(6), 557–561.
Henderson, D. C., Cagliero, E., Gray, C., Nasrallah, R. A., Hayden, D. L., Schoenfeld, D. A., & Goff, D. C. (2000a). Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: a five-year naturalistic study. American Journal of Psychiatry, 157(6), 975–981.
Henderson, D. C., Cagliero, E., Gray, C., Nasrallah, R. A., Hayden, D. L., Schoenfeld, D. A., & Goff, D. C. (2000b). Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: a five-year naturalistic study. American Journal of Psychiatry, 157(6), 975–981.
Jafari, S., Fernandez‐Enright, F., & Huang, X. (2012). Structural contributions of antipsychotic drugs to their therapeutic profiles and metabolic side effects. Journal of Neurochemistry, 120(3), 371–384.
Kang, S. H., & Lee, J. Il. (2015). Metabolic disturbances independent of body mass in patients with schizophrenia taking atypical antipsychotics. Psychiatry Investigation, 12(2), 242–248. https://doi.org/10.4306/pi.2015.12.2.242
Kenakin, T. (2003). Predicting therapeutic value in the lead optimization phase of drug discovery. Nature Reviews Drug Discovery, 2(6), 429–438.
Liebzeit, K. A., Markowitz, J. S., & Caley, C. F. (2001). New onset diabetes and atypical antipsychotics. European Neuropsychopharmacology, 11(1), 25–32.
Moisan, J., Turgeon, M., Desjardins, O., & Grégoire, J. P. (2013). Comparative safety of antipsychotics: Another look at the risk of diabetes. Canadian Journal of Psychiatry, 58(4), 218–224. https://doi.org/10.1177/070674371305800407
Olsson, E. (2015). Cardiovascular risk factors and pharmacogenetics of clozapine in schizophrenia. Inst för neurobiologi, vårdvetenskap och samhälle/Dept of Neurobiology, Care Sciences and Society.
Oruch, R., Pryme, I., Fasmer, O., & Lund, A. (2020). Quetiapine: An objective evaluation of pharmacology, clinical uses and intoxication. EC Pharmacol Toxicol, 8, 1–26.
Richards, O. C., Raines, S. M., & Attie, A. D. (2010). The role of blood vessels, endothelial cells, and vascular pericytes in insulin secretion and peripheral insulin action. Endocrine Reviews, 31(3), 343–363.
Schmidt, L., Phelps, E., Friedel, J., & Shokraneh, F. (2019). Acetylsalicylic acid (aspirin) for schizophrenia. Cochrane Database of Systematic Reviews, 8.
Schwenkreis, P., & Assion, H.-J. (2004). Atypical antipsychotics and diabetes mellitus. The World Journal of Biological Psychiatry, 5(2), 73–82.
Shen, H., Wu, D., Wang, S., Zhao, M., Sun, W., Zhu, X., Zhang, N., Yao, H., Cui, Q., & Xiao, H. (2018). Accepted Article Atypical Antipsychotic Administration in Schizophrenic Patients Leads to Elevated Lipoprotein-Associated Phospholipase A2 Levels and Increased Cardiovascular Risk: A Retrospective Cohort Study. Basic & Clinical Pharmacology & Toxicology. https://doi.org/10.1111/bcpt.13079
Shirzadi, A. A., & Ghaemi, S. N. (2006). Side effects of atypical antipsychotics: extrapyramidal symptoms and the metabolic syndrome. Harvard Review of Psychiatry, 14(3), 152–164.
Wysokiński, A. (2014). Blood levels of glucose and insulin and insulin resistance in patients with schizophrenia on clozapine monotherapy. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 8(4), 236–241.
Yatham, L. N., Goldstein, J. M., Vieta, E., Bowden, C. L., Grunze, H., Post, R. M., Suppes, T., & Calabrese, J. R. (2005). Atypical antipsychotics in bipolar depression: potential mechanisms of action. Journal of Clinical Psychiatry, 66(Suppl 5), 40–48.
