Obesity and diabetes are much more common in patients with mental illnesses compared to the general population and they are linked to adverse cardiovascular (CV) outcomes. Antipsychotic, but also antidepressant medications have been associated with adverse metabolic outcomes. Newer diabetes medications, for example GLP (Glucagon-Like Peptide) analogues, improve not only diabetes control, they also promote weight loss and some (f.i. liraglutide) lower adverse CV outcomes making them ideal agents for mentally diseased patients. Studies of these at-risk patients are scarce and inconclusive. While one study of prediabetic patients on antipsychotics showed improved glucose tolerance and weight loss on a GLP analogue [liraglutide (Larsen JR et al., 2017)], another did not [exenatide (Ishoy PL et al., 2017)]. We thus analyzed diabetic patients on antipsychotics after referral to our diabetes clinic between 2010-2016. Forty five patients were included in this retrospective study; ten were started on GLP analogues (cases), thirty five were treated with alternative diabetic agents (controls). Cases and controls did not significantly differ in age, sex, height, weight and medical therapies at the time of referral. Within one year, a significant reduction in HbA1c (mean±SE) was noted in both groups (-1.25±0.25% for cases, -1.47±0.45% for controls). However, patients on GLP analogues lost 7.1±2.6kg, whereas control patients gained 1.9±1.4kg (p=0.005). Within the entire cohort, we also noted a blunted HbA1c reduction in patients on antidepressants (-0.69±0.33% ON, -2.97±0.6% OFF antidepressants, p=0.001). The opposite trend was observed for patients on GLP analogues, a greater HbA1c reduction was seen for those ON antidepressants.
In summary, GLP analogues are superior for both diabetes and weight control in diabetic patients on antipsychotics plus/minus antidepressants. Future studies are needed to confirm and validate these promising trends.
L. Perlis: None. S.U. Miedlich: None.
