Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study

doi:10.1136/bmj.325.7358.243

BMJ 2002;325:243 ( 3 August )

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Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study

Carol E Koro, postgraduate, ^a Donald O Fedder, professor, ^b Gilbert J L'Italien, director, ^f Sheila S Weiss, assistant professor, ^b Laurence S Magder, associate professor, ^c Julie Kreyenbuhl, assistant professor, ^d Dennis A Revicki, chairman of board, ^g Robert W Buchanan, professor. ^e

^a Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA, ^b Pharmacy Practice and Science, University of Maryland, ^c Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, ^d VA Capital Network Mental Illness Research, Education, and Clinical Center, University of Maryland, ^e Maryland Psychiatric Research Center, University of Maryland, ^f Decision Sciences Outcomes Research, Bristol-Myers Squibb Pharmaceutical Research Institute, Wallingford, CT 06492, USA, ^g Center for Health Outcomes Research, MEDTAP International, Bethesda, MD 20814, USA

Correspondence to: C E Koro ckoro001{at}umaryland.edu

Objective: To quantify the association between olanzapineanddiabetes.
Design: Population based nested case-controlstudy.
Setting: United Kingdom based General Practice ResearchDatabase comprising 3.5 million patients followed between 1987and2000.
Participants: 19 637 patients who had been diagnosed ashaving and treated for schizophrenia. 451 incident cases of diabeteswere matched with 2696controls.
Main outcome measures: Diagnosis and treatment ofdiabetes.
Results: Patients taking olanzapine had a significantlyincreased risk of developing diabetes than non-users of antipsychotics(odds ratio 5.8, 95% confidence interval 2.0 to 16.7) and thosetaking conventional antipsychotics (4.2, 1.5 to 12.2). Patientstaking risperidone had a non-significant increased risk of developingdiabetes than non-users of antipsychotics (2.2, 0.9 to 5.2) andthose taking conventional antipsychotics (1.6, 0.7 to 3.8).
Conclusion: Olanzapine is associated with a clinicallyimportant and significant increased risk ofdiabetes.

What is already known on this topic
Recent evidence has suggested an association between the newer class of antipsychotics and diabetes

Most of these studies were case reports

The association has not been confirmed in epidemiological studies, with the relation adjusted for comorbid factors

What this study adds
Olanzapine is associated with a clinically important increased risk of diabetes

After adjustment for relevant risk factors this association is significant

The metabolic consequences of olanzapine should be considered by doctors giving treatment

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