Monitoring for metabolic side effects of antipsychotic drugs

Risk factor	Baseline	Initial monitoring			Long-term monitoring
Risk factor	Baseline	4 weeks	8 weeks	12 weeks	Quarterly	Annually
Personal or family history (diabetes, hypertension, or cardiovascular disease)	X					X
Weight (body mass index)	X	X	X	X	X
Waist circumference	X			X		X
Blood pressure	X			X	X
Fasting glucose or HbA1c^*	X			X		X
Fasting lipid profile	X	^¶		X		X

* HbA1c is usually more practical to obtain than fasting glucose, but either can be used.

¶ For patients taking olanzapine, quetiapine, clozapine.

Adapted from:

American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27:596.
De Hert M, Detraux J, van Winkel R, et al. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nat Rev Endocrinol 2011; 8:114.
De Hert M, Dekker JM, Wood D, et al. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 2009; 24:412.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 Suppl 1:S62.
Cohn T. Metabolic monitoring for patients on antipsychotic medications. Psychiatric Times 2013.

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