A new study found that diabetic elderly patients who are prescribed antipsychotic medication for the first time are at an increased risk of hyperglycemia, especially within the first two weeks of medication regimen. The same study also found that serious hyperglycemic episode among some diabetic older patients who recently started an antipsychotic medication was 50 percent higher compared to their counterparts who haven’t taken the drug for the last 6 months.

Dr. Lorraine L. Lipscombe of the Clinical Evaluative Sciences at the University of Toronto, therefore, recommends that physicians should be more keen and vigilant in monitoring glycemic levels in seniors with diabetes who begin antipsychotic therapy. Dr. Lipscombe, the lead author of the study, is also affiliated with the Women’s College Research Institute at Women’s College Hospital in Ontario, Canada.

“If you’re going to be starting one of these antipsychotic drugs in this patient population, you need to pay attention to diabetes control both before you start the drug and also shortly after,” said Dr. Lipscombe.
Diabetes in older patients is more difficult to control compared to that in younger people. This is because older people are less likely to report symptoms or report irregularity in their thirst, urination, or signs of dehydration, which makes them more vulnerable to metabolic problems.

The researchers noted that almost 70 percent of hyperglycemic events among new antipsychotic users occurred within 14 days of initiation of treatment. “The effect of antipsychotics on dopamine levels, which previous research suggests plays a role in regulating blood glucose levels, is one potential mechanism,”
Dr. Lipscombe added.

“Other studies have suggested that antipsychotics may affect insulin secretion.”

In conclusion, Dr. Lipscombe said that doctors should consider other treatment approaches in older patients with diabetes. “We encourage healthcare practitioners to think about alternatives—either pharmacological or nonpharmacological. We know that sometimes those alternatives may require a little more time and labor but they should at least be considered in the more vulnerable populations.”

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