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Atypical antipsychotic‐induced diabetes mellitus: an update on epidemiology and postulated mechanisms

Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome are rare, but potentially fatal complications of antipsychotic‐associated hyperglycaemia. The mechanisms for this remain unclear, but are probably multifactorial. The suggested reasons include drug‐induced weight gain and adiposity, development of the metabolic syndrome, antagonism of serotonin (5‐hydroxytryptamine) receptors, drug‐induced leptin resistance, dyslipidaemia mediated pancreatic β‐cell damage and hepatocyte transcription factor dysregulation. Patients with schizophrenia are known to be at a higher genetic risk of developing diabetes mellitus and cardiovascular disease. This review emphasizes a rare case of hyperosmolar hyperglycaemic syndrome in a young man with schizophrenia and discusses proposed mechanisms for the development of antipsychotic‐associated diabetes mellitus.