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Hearts_and_Minds

Type 2 Diabetes

Diabetes is a problem related to how your body uses sugar. It is a serious medical problem. There are several types of diabetes, but we will focus on the adult-onset type, also called Type 2 diabetes. Type 2 diabetes results from cells in person's body failing to use insulin properly. Insulin enables cells in the body to use glucose (a kind of sugar) to turn it into energy. In Type 2 diabetes, the rising glucose levels seen in the bloodstream are an indicator that the pancreas is unable to maintain production of enough insulin. Being overweight, especially around the middle/abdomen, is the most common underlying cause of adult-onset diabetes. Having a family history of adult-onset diabetes is another risk. By becoming more active and engaging in a weight-loss program, you may be able to halt and even reverse adult-onset diabetes. Talk with your health care provider before beginning an exercise program.

SGAs and Diabetes Risk

All medications have side effects. Side effects may be rare or common, serious or merely annoying. A medicine with frequent mild side effects may be tolerated by a majority of people and be regarded as relatively safe. On the other hand, if a medicine has more serious side effects, it informs treatment decisions and indicates a need for risk-monitoring.

You should review and discuss the risk of side effects versus the expected benefits of any medication with your health care provider. In many cases, especially when considering the options of nontreatment, even serious side effects may be worth the risk.

Some medications offer greater risks than others, and the same is true for SGAs. The chart below from Diabetes Care offers information on how these various medicines are ranked in terms of risk. It is imperative that you understand this information as you choose a medication in partnership with your health care provider. Talk with your health care provider about the relationship between your medicine and diabetes or diabetes risks. Exploring research studies, such as the CATIE study, that evaluate the effectiveness of medications is also recommended.

Heart Risks and SGAs


Drug Weight gain Risk for Diabetes Worsening lipid profile
Clozapine +++ + +
Olanzapine +++ + +
Risperidone ++ D D
Quetiapine ++ D D
Aripipazaole +/- - -
Ziprasidone +/- - -
+ = increased effect; - = no effect; D= discrepant results.
*Newer drugs with limited long-term data

Source: Diabetes Care, February 2004
Note: This ADA chart was created in 2004. Newer SGAs such as Paliperidone (Invega) and Asenapine (Saphris),
which are not included on this chart, do carry heart-related side effects. As these are newer medications,
more will be learned about the details of their side effects over time. To keep up
to date on the latest FDA-approved medicines, visit www.fda.gov.

Be sure to engage in a conversation with your health care provider about what medicine could be the best fit for you. While initial awareness of increased SGA risk for weight gain, metabolic syndrome and diabetes was slow to evolve, it is now very clear to the FDA as well as to individuals, family members and doctors.

Symptoms

Type 2 Diabetes can exist in a person for years before it is identified. The most common symptoms of undetected diabetes are increased thirst and urination. Fatigue is also common. Other signs include dry and itchy skin, blurry vision and slowly healing wounds. If you notice any of these symptoms, it is important to get your sugar (glucose) level checked when you see your health care provider. A simple blood test will tell you if you are either at risk for, or if you have, Type 2 diabetes. A fasting blood sugar over 126mg/dl is one key diagnostic criteria.

Monitoring

The best practices for heart-risk prevention and diabetes monitoring in people who take SGAs are ever-evolving. One of the key documents in both of these fields is the 2004 American Diabetes Association /American Psychiatric Association Guidelines. These Guidelines have since been viewed as not aggressive enough in monitoring for lipids like triglycerides and cholesterol by many clinicians. The American Diabetes Association, www.diabetes.org, offers the latest information and guidelines for diabetes generally, which include information on children and teens that are at increased risk for developing diabetes.

Here are a few terms to inform your conversation with your health care provider and to help you as you consider monitoring measures:

  • Glucose is a measure of the sugar in your blood plasma. It can be measured any time.
  • Fasting glucose is when you haven't eaten for a period of time before the blood is drawn. That is a more detailed test for diabetes risk.
  • Oral Glucose tolerance test (OGTT) is a specific test to assess the body's ability to manage glucose. This is the gold-standard test for diabetes
  • Hemoglobin A1C (pronounced AY one see) is a measure of the sugar control in the preceeding weeks. For most labs the number should be below six or seven. Numbers over that indicate chronically poor sugar control (diabetes).

The American Diabetes Association suggests that if your blood glucose levels are in the normal range, it is a good idea to get checked every three years. If you have pre-diabetes, you should be checked for Type 2 diabetes every one to two years after your diagnosis.

Talk with your health care provider about your concerns. If you are taking SGAs, you should have or obtain a baseline of data that will help you monitor your risks. The chart below outlines a suggested schedule for you to discuss with your health care provider.

Schedule for Monitoring Patients On Second-Generation Antipsychotics


Baseline 4 weeks 8 weeks 12 weeks Quarterly Annually Every 5 years
Personal/family history X X
Weight (BMI) X X X X X
Waist circumference X X
Blood pressure X X X
Fasting plasma glucose X X X
Fasting lipid profile X X X

Source: Diabetes Care, February 2004

The key to monitoring your risks is to be sure that you and your health care provider are mindful of them and are thinking about how to prevent, detect and intervene. Studies show people who take SGAs are simply not being routinely informed or checked for these problems.

<<back to Metabolic Syndrome and Diabetes Main


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