Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: A five-year naturalistic study

Objective: The goal of this 5-year naturalistic study of patients treated w ith clozapine was to examine the incidence of treatment-emergent diabetes m ellitus in relation to other factors, including weight gain, lipid abnormal ities, age, clozapine dose, and treatment with valproate. Method: Data on age, gender, race, diagnosis, family history of diabetes, a nd age at clozapine initiation were collected from medical records of 82 ou tpatients with schizophrenia or schizoaffective disorder. Clozapine dose, d ata on use of valproate, and laboratory rest results were recorded at 6-mon th intervals. Results: The mean age at the time of clozapine initiation of the 82 patient s was 36.4 years; 26.8% of the patients were women, and 91.5% were Caucasia n. The mean baseline weight was 175.5 Ib, and the mean body mass index was 26.9 kg/m(2). Thirty patients (36.6%) were diagnosed nosed with diabetes du ring the 5-year follow-up. Weight gain, use of valproate, and total daily d ose of clozapine were not significant risk factors for developing diabetes mellitus. Patients experienced significant weight gain that continued until approximately month 46 from initiation of clozapine. There was a nonsignif icant increase in total serum cholesterol and a significant increase in ser um triglycerides level. Conclusions: The results support the hypotheses that patients treated with clozapine experience significant weight gain and lipid abnormalities and ap pear to be at increased risk for developing diabetes.