Risk of diabetes and schizophrenia

Schizophrenic patients even those who are untreated are known to suffer from diabetes mellitus more often than the general population. Antipsychotic drug therapy, especially using atypical antipsychotic drugs, markedly increases the risk for the development of diabetes mellitus. Therapy with olanzapine and clozapine is followed by weight gain and independently from this, increases the incidence of diabetes. Therefore, in schizophrenic patients measurements of blood glucose in regularly intervals are recommended to exclude diabetes. In addition, patients should be informed about the clinical signs of diabetes.

Diabetes therapy in psychotic patients should focus on the leading pathophysiological cause of the disease: Insulin resistance or insulin deficiency. First-line medication in insulin resistant patients includes metformin and glitazones while in the rare case of leading insulin deficiency therapy with sulfonylureas or insulin is recommended. Patients education should focus on essentials such as dietary recommendations and self-control and also should base on practical skills.