Rapid Metabolic Changes in First 90 Days of Antipsychotic Use
New research reveals significant spikes in blood sugar and weight within the initial three months of starting second-generation antipsychotics.
Blood sugar levels rise 14 times faster and weight increases nine times faster in the first 90 days of treatment.
Monitoring both weight and glycemia is crucial, as they do not always correlate.
Women are particularly vulnerable, experiencing greater metabolic changes than men.
A recent study has highlighted that significant metabolic changes occur within the first 90 days of initiating treatment with second-generation antipsychotics, particularly among women. Researchers found that blood sugar levels and body weight increase sharply during this period, with A1c levels rising approximately 14 times faster and weight increasing about nine times faster compared to pre-treatment levels.
The study, which analyzed the electronic health records of nearly 97,000 adults with severe mental illness in England between 2000 and 2023, aimed to clarify the timing and nature of these metabolic changes. Participants who had received at least two prescriptions for oral antipsychotics were included, while those with pre-existing type 2 diabetes were excluded. The findings were published in The Lancet Psychiatry on October 14.
During the first 90 days of treatment, A1c levels increased at an accelerated rate of 0.12 mmol/mol per week, compared to just 0.01 mmol/mol per week before treatment. Weight gain also surged from 0.02 kg per week prior to treatment to 0.21 kg per week during the initial treatment phase. Notably, the study indicated that these metabolic changes did not always occur in tandem, suggesting that relying solely on weight monitoring could overlook critical glycemic risks.
The implications of these findings are significant, particularly for clinicians who prescribe antipsychotics. The researchers emphasized the importance of early metabolic monitoring and intervention, especially within the first three months of treatment. They recommended that clinicians assess both weight and glycemia at baseline and again around the 12-week mark to better manage potential metabolic risks.
Looking ahead, the study suggests that patients at higher metabolic risk may benefit from early lifestyle interventions and a review of their antipsychotic medications. The researchers also raised the possibility of considering metformin for patients beginning treatment with olanzapine or clozapine, as a proactive measure against metabolic changes. This approach aims to address early, often asymptomatic metabolic alterations rather than waiting for more severe complications to arise.
