Is quetiapine (antipsychotic medication) contraindicated in patients with diabetes mellitus?

From the Guidelines

Quetiapine should be used with caution in diabetic patients due to its potential to affect blood glucose control, as it can increase the risk of hyperglycemia and worsen glycemic control in patients with diabetes. This antipsychotic medication can cause weight gain, increase insulin resistance, and alter glucose metabolism, all of which can complicate diabetes management 1. For diabetic patients who require quetiapine for psychiatric conditions, more frequent blood glucose monitoring is recommended, especially during the initial months of treatment or after dose adjustments. Healthcare providers may need to adjust diabetes medications to maintain proper glucose control. The metabolic effects of quetiapine are thought to be related to its antagonism of histamine H1 receptors and serotonin 5-HT2C receptors, which affect appetite regulation and insulin sensitivity.

Some key points to consider when prescribing quetiapine to diabetic patients include:

• Monitoring blood glucose levels regularly, especially during the initial months of treatment or after dose adjustments
• Adjusting diabetes medications as needed to maintain proper glucose control
• Considering the potential for weight gain and increased insulin resistance when selecting antipsychotic medications
• Weighing the psychiatric benefits of quetiapine against the potential risks to glucose control and overall health. Despite these concerns, quetiapine may still be prescribed to diabetic patients when the psychiatric benefits outweigh the risks, but with appropriate monitoring and management of blood glucose levels 1.

From the FDA Drug Label

Atypical antipsychotic drugs have been associated with metabolic changes that include hyperglycemia/diabetes mellitus, dyslipidemia, and body weight gain. Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment.

Quetiapine may be a concern in diabetics due to its association with hyperglycemia/diabetes mellitus.

• Patients with diabetes should be monitored regularly for worsening glucose control.
• Patients with risk factors for diabetes should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment 2.

From the Research

Issue with Quetiapine in Diabetics

• The use of quetiapine has been associated with an increased risk of developing diabetes, particularly in patients with schizophrenia or bipolar disorder 3.
• A study found that almost all patients who developed quetiapine-associated diabetes had dyslipidemia and increased BMI, and that discontinuation of quetiapine led to amelioration of diabetes in several patients 3.
• Another study suggested that quetiapine, as well as other second-generation antipsychotics, can produce weight gain, leading to insulin resistance, glucose intolerance, and metabolic syndrome, which are risk factors for the emergence of diabetes 4.
• However, a cohort study found that the use of low-dose quetiapine was not associated with an excess risk of type 2 diabetes compared to selective serotonin reuptake inhibitors (SSRIs) 5.
• A retrospective cohort study found that short-term, low-dose quetiapine may be comparable to risperidone in terms of mortality and infectious outcomes in postoperative patients with diabetes 6.
• In contrast, a study on the safety of low-dose quetiapine for insomnia in older adults found that it was associated with significantly higher rates of mortality, dementia, and falls compared to trazodone and mirtazapine 7.

Key Findings

• Quetiapine may increase the risk of developing diabetes, particularly in patients with schizophrenia or bipolar disorder 3, 4.
• Low-dose quetiapine may not be associated with an excess risk of type 2 diabetes compared to SSRI 5.
• Short-term, low-dose quetiapine may be comparable to risperidone in terms of mortality and infectious outcomes in postoperative patients with diabetes 6.
• Low-dose quetiapine for insomnia in older adults may be associated with higher rates of mortality, dementia, and falls compared to other medications 7.