Monitoring Metabolic Side Effects

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While precise mechanisms underlying the glucose dysregulation and dyslipidemia during antipsychotic treatment are not yet fully elucidated, available data underscore the need for clinicians to be informed about weight, glucose, and lipid levels in patients taking atypical antipsychotics.

Glucose and insulin metabolism in humans can be assessed by several different methods, which can be listed in an approximate rank order ranging from least to most sensitive: random plasma glucose, glycated hemoglobin (A1C), fasting plasma glucose, homeostasis model assessment insulin resistance, postprandial glucose, oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT), frequently sampled IVGTT with Minimal Model analysis, and hyperinsulinemiceuglycemic and hyperglycemic clamps. Random plasma glucose offers limited sensitivity and may be falsely reassuring. In addition, no American Diabetes Association (ADA) or WHO criteria exist to diagnose impairments in glucose metabolism based on random plasma glucose levels in otherwise asymptomatic patients.’ ‹’ ‹