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Titolo:
Euglycemic clamp study in clozapine-induced diabetic ketoacidosis
Autore:
Avram, AM; Patel, V; Taylor, HC; Kirwan, JP; Kalhan, S;
Indirizzi:
Lutheran Hosp, Cleveland Clin Hlth Syst, Dept Med, Cleveland, OH 44113 USALutheran Hosp Cleveland OH USA 44113 t, Dept Med, Cleveland, OH 44113 USA Fairview Hosp, Cleveland Clin Hlth Syst, Dept Med, Cleveland, OH USA Fairview Hosp Cleveland OH USA in Hlth Syst, Dept Med, Cleveland, OH USA Case Western Reserve Univ, Dept Med, Cleveland, OH 44106 USA Case Western Reserve Univ Cleveland OH USA 44106 Cleveland, OH 44106 USA Case Western Reserve Univ, Schwartz Ctr Metab & Nutr, Dept Pediat, Cleveland, OH 44106 USA Case Western Reserve Univ Cleveland OH USA 44106 Cleveland, OH 44106 USA Metrohlth Med Ctr, Cleveland, OH USA Metrohlth Med Ctr Cleveland OH USAMetrohlth Med Ctr, Cleveland, OH USA
Titolo Testata:
ANNALS OF PHARMACOTHERAPY
fascicolo: 11, volume: 35, anno: 2001,
pagine: 1381 - 1387
SICI:
1060-0280(200111)35:11<1381:ECSICD>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
ISLET-CELL ANTIBODIES; INSULIN-RESISTANCE; GLUCOSE-TOLERANCE; WEIGHT-GAIN; TNF-ALPHA; MELLITUS; ONSET; MEDICATIONS; PREVALENCE;
Keywords:
clozapine; diabetes mellitus; euglycemic clamp; ketoacidosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Taylor, HC Lutheran Hosp, Cleveland Clin Hlth Syst, Dept Med, 1730 W 25th St, Cleveland, OH 44113 USA Lutheran Hosp 1730 W 25th St Cleveland OH USA 44113 H 44113 USA
Citazione:
A.M. Avram et al., "Euglycemic clamp study in clozapine-induced diabetic ketoacidosis", ANN PHARMAC, 35(11), 2001, pp. 1381-1387

Abstract

OBJECTIVE: To describe the fifth case of clozapine-induced diabetic ketoacidosis (DKA) with complete resolution of abnormal glucose metabolism after discontinuation of clozapine as assessed by oral glucose tolerance testing (OGTT) and the first to be serially studied with markers of pancreatic autoimmunity; to demonstrate insulin resistance using the euglycemic clamp study and reduced pancreatic insulin reserve using intravenous glucose tolerance testing (IVGTT) in clozapine-induced diabetes mellitus and DKA, when the OGTT was normal; and to systematically review the previously described cases of clozapine-induced diabetes mellitus and DKA. CASE SUMMARY: A 33-year-old white man without past or family history of diabetes mellitus presented with DKA after eight months of clozapine therapy (50 mg twice daily). After treatment of DKA and discontinuation of clozapine, glucose tolerance and concurrent serum insulin concentrations reverted to normal as measured by two OGTT performed 60 and 320 days after resolutionof DKA. DISCUSSION: Antiislet-cell antibodies, antiglutamic acid decarboxylase antibodies, and human insulin antibody were negative on two separate occasions. Euglycemic clamp study demonstrated insulin resistance manifested by a glucose disposal rate of approximately 55% of mean normal values. IVGTT demonstrated a low rate of glucose disappearance (K-G = 0.95) and diminished first-phase insulin response when OGTT was normal, indicating impairment in insulin sensitivity and reduction in beta cell function 323 days after discontinuance of clozapine. This adverse reaction is considered probable according to the Naranjo probability scale. CONCLUSIONS: The occurrence of cases of DKA and new or worsening diabetes mellitus in patients using clozapine suggests a causal relationship. We hypothesize that the mechanism by which clozapine may produce glucose intolerance may require a preexisting latent defect in insulin secretion and insulin action. With the administration of clozapine, some of these patients may develop worsening insulin resistance and may fail to mount an appropriate compensatory beta cell insulin secretion for the degree of insulin resistance. As a consequence, hyperglycemia develops and its persistence results in glucose toxicity, further suppressing beta cell insulin secretion. Such combined defects in insulin secretion and sensitivity are known to be synergistic, leading to the development of abnormal glucose tolerance, which can beclinically manifested as a spectrum ranging from impaired glucose tolerance through sever hyperglycemia to DKA. Patients being started on clozapine should be carefully followed for the development or worsening of diabetes mellitus, regardless of the dose of the drug.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/01/20 alle ore 11:39:58