4.6 Article

Relationship between body mass index and insulin resistance in patients treated with second generation antipsychotic agents

Journal

JOURNAL OF PSYCHIATRIC RESEARCH
Volume 44, Issue 8, Pages 493-498

Publisher

PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.jpsychires.2009.11.007

Keywords

Olanzapine; Second generation antipsychotic medications; Insulin resistance; Obesity

Categories

Funding

  1. Eli Lilly
  2. NIH Research [RR-00070, K23MH079114]

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Second generation antipsychotics (SGAs) can increase weight gain and weight-induced insulin resistance. Recent studies have suggested weight-independent effects of certain SGAs on insulin resistance: however the magnitude of these effects and the relationship between BMI and insulin resistance in patients on SGAs are not established. To evaluate, the relationship between body mass index (BMI) and insulin resistance in 54 patients being stably treated with olanzapine (n = 19), risperidone (n = 16), or aripiprazole (n = 19) was compared with data from a large reference population (n = 201) not on SGAs. Insulin resistance was directly quantified by measuring the steady-state plasma glucose (SSPG) concentration during the insulin suppression test. The relationship between BMI and SSPG was similar between the SGA (r = 0.58) and the reference population (r = 0.50). When SSPG was standardized based on expected values for the reference population, patients on olanzapine had a higher degree of insulin resistance (mean z-score +/- SD, 0.68 +/- 0.9) than expected for level of BMI compared with those on aripiprazole (-0.25 +/- 1) and risperidone (-0.3 +/- 0.9), F(2, 51) = 6.28 (p = 0.004). Thus, olanzapine group was 0.76 SD above the reference population or in the 78 percentile for insulin resistance. SSPG was correlated with fasting plasma insulin concentration (0.78 (0.64-0.87), p < 0.001) but not fasting glucose concentration (0.15 (-0.13-0.40), p = 0.29). In conclusion, BMI contributes a quarter to a third of the variance in insulin resistance in the SGA population similar to the reference population. Olanzapine also appears to have an independent effect on insulin resistance that is above and beyond obesity. (C) 2009 Elsevier Ltd. All rights reserved.

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