Nach der Markteinführung der so genannten „atypischen” Neuroleptika ist mehrfach über erhöhte Blutzuckerwerte und auch über einen Diabetes mellitus Typ II bei Patienten, die mit diesen Medikamenten behandelt wurden, berichtet worden. In dieser Übersicht sollen die bisher in der Literatur beschriebenen Berichte und Studien referiert werden. Einige epidemiologische Studien zeigen, dass ein Diabetes mellitus im Vergleich zu klassischen Neuroleptika gehäuft bei „atypischen” auftritt. Nach den bisher vorliegenden Daten ist eine Hyperglykämie und ein Diabetes mellitus Typ II besonders bei Patienten, die mit Clozapin und Olanzapin behandelt wurden, beobachtet worden. Auch eine diabetische Ketoazidose wurde vor allem bei der Behandlung mit diesen Medikamenten berichtet. Die zugrunde liegenden Pathomechanismen sind noch nicht hinreichend geklärt. Einige Befunde deuten darauf hin, dass wahrscheinlich einer durch „atypische” Neuroleptika gesteigerten Sekretion von Insulin und möglicherweise auch Leptin eine wichtige Rolle zukommt. Da Übergewicht ein wichtiger Risikofaktor für einen Diabetes mellitus Typ II ist, kommt möglicherweise auch der gewichtsinduzierenden Wirkung von atypischen Neuroleptika eine wichtige Rolle zu. Da ein Diabetes mellitus Typ II häufig zu schwerwiegenden Folgeerkrankungen führt, sollte den Blutzuckerwerten in der Behandlung mit „atypischen” Neuroleptika mehr Aufmerksamkeit gewidmet werden.
Abstract
After the introduction of the so-called „atypical antipsychotics” in the clinical practice hyperglycemia as well as increased triglyceride and cholesterol serum levels were reported in patients treated with some of these agents. The studies and case reports available up to now were reviewed. Some epidemiologic studies show that diabetes mellitus occurs more often in patients treated with atypical antipsychotics if compared to conventional antipsychotics. The available data show that hyperglycemia and diabetes mellitus type II were particularly observed in patients receiving clozapine and olanzapine. Also diabetic ketoacidosis was most frequently reported in patients treated with these drugs. The underlying pathomechanism still remains widely unclear. There is some evidence for an important role of insulin and also leptin. Their secrection seems to be influenced by some atypical antipsychotics. Since overweight is a known risk-factor for diabetes mellitus type II, the weight inducing effect of atypical antipsychotics may also play an important role. Since diabetes mellitus type II often lead to severe diseases, the serum glucose levels should be paid more attention in the treatment with atypical neuroleptics.
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