Olanzapine-induced glucose dysregulation

OBJECTIVE: To report a patient who developed severe exacerbation of type 2 diabetes mellitus after the initiation of olanzapine therapy. CASE SUMMARY: A 54-year-old African-American woman developed severe glucose dysregulation 12 days after the initiation of olanzapine. Prior to starting olanzapine therapy, the patient's diabetes was controlled by diet modification with a glycosylated hemoglobin of 6.5%. During olanzapine therapy, blood glucose concentrations could not be regulated despite use of antidiabetic agents, insulin, and dietary interventions. The patient also gained a total of 13 kg. Two weeks after discontinuation of all antipsychotic medications (olanzapine, quetiapine), the patient's blood glucose concentrations became better regulated and remained better controlled until discharge. DISCUSSION: All atypical antipsychotics are associated with weight gain. Obesity is a well-documented risk factor for developing type 2 diabetes mellitus. Currently there are only six published reports that implicate olanzapine as being associated with glucose dysregulation. The exact cause of glucose dysregulation with olanzapine is unclear, but weight gain does not seem to be the sole etiology. It has been hypothesized that serotonin (5-HT1A) antagonism may decrease the responsiveness of the pancreatic beta-cells. This would then result in inappropriately low insulin secretion and, therefore, hyperglycemia. Based on the Naranjo probability scale, the likelihood that olanzapine caused the glucose dysregulation in our patient was possible. CONCLUSIONS: Although olanzapine has shown greater clinical efficacy and is associated with fewer extrapyramidal side effects than typical antipsychotics, it may produce exacerbation or new emergence of diabetes mellitus. Further examination of the incidence and etiology of glucose dysregulation after the initiation of olanzapine therapy is necessary.

This article has been cited by other articles:

				B. L. Lambert, F. E. Cunningham, D. R. Miller, G. W. Dalack, and K. Hur Diabetes Risk Associated with Use of Olanzapine, Quetiapine, and Risperidone in Veterans Health Administration Patients with Schizophrenia Am. J. Epidemiol., October 1, 2006; 164(7): 672 - 681. [Abstract] [Full Text] [PDF]

				G. M. Simpson, I. D. Glick, P. J. Weiden, S. J. Romano, and C. O. Siu Randomized, Controlled, Double-Blind Multicenter Comparison of the Efficacy and Tolerability of Ziprasidone and Olanzapine in Acutely Ill Inpatients With Schizophrenia or Schizoaffective Disorder Am J Psychiatry, October 1, 2004; 161(10): 1837 - 1847. [Abstract] [Full Text] [PDF]

				N. Abdullah, L. Voronovitch, S. Taylor, and S. Lippmann Olanzapine and Quick-Response Hyperglycemia Psychosomatics, April 1, 2003; 44(2): 175 - 176. [Full Text] [PDF]

				N. Abdullah, L. Voronovitch, S. Taylor, and S. Lippmann Olanzapine and Haloperidol: Potential for Neutropenia? Psychosomatics, February 1, 2003; 44(1): 83 - 84. [Full Text]

				J.-P. Lindenmayer, P. Czobor, J. Volavka, L. Citrome, B. Sheitman, J. P. McEvoy, T. B. Cooper, M. Chakos, and J. A. Lieberman Changes in Glucose and Cholesterol Levels in Patients With Schizophrenia Treated With Typical or Atypical Antipsychotics Am J Psychiatry, February 1, 2003; 160(2): 290 - 296. [Abstract] [Full Text] [PDF]

				S. Shahzad, M.-I. Suleman, H. Shahab, I. Mazour, A. Kaur, P. Rudzinskiy, and S. Lippmann Cataract Occurrence With Antipsychotic Drugs Psychosomatics, October 1, 2002; 43(5): 354 - 359. [Abstract] [Full Text] [PDF]

				B. SPIVAK, S. S. ALAMY, L. F. JARSKOG, B. B. SHEITMAN, and J. A. LIEBERMAN Ziprasidone Alternative for Olanzapine-Induced Hyperglycemia Am J Psychiatry, September 1, 2002; 159(9): 1606 - 1606. [Full Text] [PDF]

				C. E Koro, D. O Fedder, G. J L'Italien, S. S Weiss, L. S Magder, J. Kreyenbuhl, D. A Revicki, and R. W Buchanan Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study BMJ, August 3, 2002; 325(7358): 243 - 243. [Abstract] [Full Text] [PDF]

				J. W. Newcomer, D. W. Haupt, R. Fucetola, A. K. Melson, J. A. Schweiger, B. P. Cooper, and G. Selke Abnormalities in Glucose Regulation During Antipsychotic Treatment of Schizophrenia Arch Gen Psychiatry, April 1, 2002; 59(4): 337 - 345. [Abstract] [Full Text] [PDF]

				K. Melkersson and A.-L. Hulting Recovery From New-Onset Diabetes in a Schizophrenic Man After Withdrawal of Olanzapine Psychosomatics, February 1, 2002; 43(1): 67 - 70. [Full Text]

				A. H. Glassman and J. T. Bigger Jr. Antipsychotic Drugs: Prolonged QTc Interval, Torsade de Pointes, and Sudden Death Am J Psychiatry, November 1, 2001; 158(11): 1774 - 1782. [Abstract] [Full Text] [PDF]

				B. Luna and M. N. Feinglos Drug-Induced Hyperglycemia JAMA, October 24, 2001; 286(16): 1945 - 1948. [Full Text] [PDF]