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Clozapine use linked to onset of diabetes and hyperglycemia

מתוך medicontext.co.il
NEW YORK (Reuters Health) – There appears to be a causal relationship between clozapine use and the onset of hyperglycemia and diabetes, researchers from the FDA's Center for Drug Evaluation and Research, Rockville, Maryland, report.

Using the FDA MedWatch and reports of other published cases from January 1990 to February 2001, Dr. Elizabeth Koller and colleagues collected data for 384 clozapine-treated patients who developed diabetes or hyperglycemia.

Three hundred twenty-three patients had new-onset hyperglycemia and 171 of these subjects met the criteria for diabetes.

In addition, 54 patients experienced exacerbation of preexisting diabetes. In seven patients, it could not be determine if diabetes was new or preexisting.

Patients with new-onset diabetes ranged from 13 to 77 years of age, with 40% or more patients presenting in the fourth decade of life. The ratio of men to women within this subgroup was 2:9, the researchers report.

Most of the patients who developed diabetes or had exacerbation of diabetes did so within 6 months after starting clozapine therapy.

Eighty cases of metabolic acidosis or ketosis developed in patients with hyperglycemia. "Twenty-five patients died during hyperglycemic episodes," Dr. Koller's team writes in the December 15, 2001 issue of The American Journal of Medicine.

In 110 patients, clozapine was discontinued. Of the 54 patients for whom data were available, 42 patients improved. In five patients for whom the dose of clozapine was reduced, four improved and one continued to need insulin, according to the report.

"The results of this survey suggest that there may be a causal relationship between clozapine and the development or worsening of diabetes," Dr. Koller's group concludes. "Therefore, clinicians should be alert to this potential complication."

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