Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes

Abstract

Antipsychotic medications are an important component in the medical management of many psychotic conditions. With the introduction of the second-generation antipsychotics (SGAs) over the last decade, the use of these medications has soared. Although the SGAs have many notable benefits compared with their earlier counterparts, their use has been associated with reports of dramatic weight gain, diabetes (even acute metabolic decompensation, e.g., diabetic ketoacidosis [DKA]), and an atherogenic lipid profile (increased LDL cholesterol and triglyceride levels and decreased HDL cholesterol). Because of the close associations between obesity, diabetes, and dyslipidemia and cardiovascular disease (CVD), there is heightened interest in the relationship between the SGAs and the development of these major CVD risk factors. To gain a better understanding of this relationship, the American Diabetes Association, the American Psychiatric Association, the American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity convened a consensus development conference 19–21 November 2003 on the subject of antipsychotic drugs and diabetes. An eight-member panel heard presentations from 14 experts drawn from the areas of psychiatry, obesity, and diabetes. Presentations were also made by a representative from the U.S. Food and Drug Administration (FDA) and by representatives from the AstraZeneca, Bristol-Myers Squibb, Janssen, Lilly, and Pfizer pharmaceutical companies. In addition, before the conference, the consensus panel was given copies of most of the known peer-reviewed, English language clinical studies published in this area, as well as additional articles from animal studies; other papers and abstracts were reviewed at the conference. With this information, the panel developed a consensus position on the following questions: 1. What is the current use of antipsychotic drugs? 2. What is the prevalence of obesity, pre-diabetes, and type 2 diabetes in the populations in which the SGAs are used? 3. What is the relationship between the use of these drugs …