Normal glucose tolerance is defined by fasting plasma glucose <100 mg/dL.
Impaired fasting glucose is defined by fasting plasma glucose 100-125 mg/dL.
Impaired glucose tolerance and impaired fasting glucose are associated with insulin resistance and appear to be risk factors for type 2 diabetes mellitus and micro/macrovascular complications.
Fasting plasma glucose ≥126 mg/dL with confirmatory repeat test.
Random plasma glucose ≥200 mg/dL in the presence of symptoms, including polyuria, polydipsia, weakness, recurrent blurred vision, vulvovaginitis or pruritus, peripheral neuropathy.
2-h oral glucose tolerance test ≥200 mg/dL.
Coordinate care with primary care provider for management of diabetes mellitus, including monitoring for secondary complications and treatment of metabolic syndrome when present.
Individuals with schizophrenia appear to have increased risk for diabetes mellitus, possibly due to a direct genetic link, but also secondary to weight gain, poor dietary habits, sedentary lifestyle, poor health habits (e.g., smoking) and treatment with atypical antipsychotics (particularly, clozapine and olanzapine).
Additionally, other psychiatric medications (e.g., mood stabilizers, antidepressants) associated with weight gain may secondarily increase risk for diabetes mellitus.
Dietary modification, including referral to a nutrition specialist.
Regular exercise, weight loss.
Smoking cessation.
Self-monitoring of blood glucose.
Agent | Recommended | Dose(s) | Special Mechanism Action | Considerations/Precautions |
|---|---|---|---|---|
Sulfonylureas Glyburide (Micronase, DiaBeta) (Glynase) Glipizide (Glucotrol) (Glucotrol XL) Glimepiride (Amaryl) | 1.25-2.5 (max 20) 1.5-3 (max 12) 2.5-5 (max 20) 2.5-5 (max 20) 1-2 (max 8) | 1-2 1-2 1-2 1 1 | Stimulate pancreatic beta islet cell insulin secretion. Increased extra-pancreatic receptor sensitivity and number. | Hypoglycemia, weight gain. |
Biguanides Metformin HCl (Glucophage) Metformin HCL ER (Fortamet, Glucophage) | 500 (max 2000) 500 (max 2000) | 2-3 1-2 | Decrease hepatic gluconeogenesis. Increase insulin sensitivity. | Contraindicated in cardiac, renal, and/or liver failure, particularly with history of alcoholism. Gastrointestinal (GI) intolerance, lactic acidosis. Weight loss. |
Alpha-glucosidase inhibitors Acarbose (Precose) Miglitol (Glyset) | 25 (max 300) 25 (max 300) | 3 3 | Decrease complex carbohydrate digestion by inhibiting alpha-glucosidase. Delay gastrointestinal absorption of carbohydrates. | GI intolerance, flatulence, abdominal discomfort, diarrhea greatest upon initiation of treatment; therefore, slow titration recommended. |
Thiazolidinediones Rosiglitazone (Avandia) Pioglitazone (Actos) | 2 (max 8) 15 (max 45) | 1-2 1 | Decrease hepatic gluconeogenesis. Increase glucose uptake in muscle and adipose tissue. Decrease fatty acid release from adipose tissue. Increase insulin sensitivity. | Fluid retention, heart failure, hepatotoxicity, weight gain. Perform baseline hepatic function before initiating treatment; coordinate further hepatic monitoring with primary care provider. |
Meglitinides Repaglinide (Prandin) Nateglinide (Starlix) | 0.5-1 (max 24) 60-120 (max 360) | 2-4 2-4 | Increase pancreatic islet beta cell insulin secretion with faster onset and shorter duration compared to sulfonylureas. | Hypoglycemia, weight gain. |
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