The Impact of Metformin on Weight and Waist Circumference in Patients Treated With Clozapine: A One-Year Retrospective Cohort Study.

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2025-03-11 DOI:10.1111/acps.13796

Bee Leng Per, Susan Loeser, Suzanne Edwards, Wen Siew Lee, Lisa R Wilton, Scott Richard Clark

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引用次数: 0

Abstract

Background: Metformin shows potential in combating clozapine-induced weight gain (CIWG). However, current evidence for its use remains limited. Through an audit we determined the prevalence of metformin use among clozapine-treated patients and its impact on weight and waist circumference (WC).

Methods: This retrospective cohort study examined electronic medical records of community-based clozapine patients under the care of metropolitan community mental health teams within the Central Adelaide Local Health Network (CALHN) from January 2014 to June 2023. We included patients treated with clozapine both with and without metformin, above 18 years of age, with complete physical monitoring data at baseline, 6, and 12 months.

Results: There were 357 patients, who met study criteria. Metformin was prescribed to 23% of patients, of whom 78% had diabetes. At baseline, WC was > 101 cm in 71% of males and > 87 cm in 86% of females, placing them at increased risk of weight-related comorbidities, including cardiovascular disease, cancer, and death. After 1 year, males and females in the highest risk group for WC-related comorbidities increased to 76.3% and 95.4%, respectively. Co-prescription of metformin with clozapine was associated with unadjusted mean weight loss (-1.67 kg) and decrease in WC (-1.00 cm). Patients not using metformin gained weight (0.68 kg) and WC (2.49 cm). Using a linear mixed-effects models adjusting for repeated measurements, age, sex, and type 2 diabetes, over 12 months, patients treated with metformin were 3.08 kg lighter than those not taking metformin (95% confidence interval [CI]: 0.54-5.62, p = 0.018). Similar models suggested patients treated with metformin showed an average 2.83 cm decrease in WC compared with those not taking metformin (CI: 0.26-5.40, p = 0.03). There was no significant interaction between difference from baseline in weight or WC and metformin dose (p > 0.05).

Discussion/conclusion: The prevalence of metformin use for CIWG appears low in this cohort, where over 84% of patients were overweight or obese. Metformin use was associated with a significantly lower incidence of weight and WC gain over 12 months. Pharmacists are crucial for educating clinicians and patients about the benefits of metformin for reducing CIWG.

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二甲双胍对氯氮平患者体重和腰围的影响：一项为期一年的回顾性队列研究。

背景：二甲双胍显示出对抗氯氮平引起的体重增加（CIWG）的潜力。然而，目前使用它的证据仍然有限。通过审计，我们确定了二甲双胍在氯氮平治疗患者中的使用情况及其对体重和腰围（WC）的影响。方法：本回顾性队列研究检查了2014年1月至2023年6月阿德莱德中央地方卫生网络（CALHN）内大都市社区精神卫生团队护理的社区氯氮平患者的电子病历。我们纳入了接受氯氮平联合或不联合二甲双胍治疗的患者，年龄大于18岁，在基线、6个月和12个月有完整的身体监测数据。结果：357例患者符合研究标准。23%的患者开了二甲双胍，其中78%患有糖尿病。基线时，71%的男性腰围为1010cm， 86%的女性腰围为87cm，这使他们患体重相关合并症的风险增加，包括心血管疾病、癌症和死亡。1年后，wc相关合并症最高风险组的男性和女性分别增加到76.3%和95.4%。二甲双胍与氯氮平合用与未经调整的平均体重减轻（-1.67 kg）和腰围减少（-1.00 cm）相关。未使用二甲双胍的患者体重增加（0.68 kg），腰围增加（2.49 cm）。使用线性混合效应模型调整重复测量、年龄、性别和2型糖尿病，在12个月内，接受二甲双胍治疗的患者比未服用二甲双胍的患者轻3.08 kg（95%置信区间[CI]: 0.54-5.62, p = 0.018）。类似模型显示，与未服用二甲双胍的患者相比，接受二甲双胍治疗的患者WC平均下降2.83 cm （CI: 0.26-5.40, p = 0.03）。与基线相比，体重和腰围的差异与二甲双胍剂量之间没有显著的相互作用（p < 0.05）。讨论/结论：在这个队列中，使用二甲双胍治疗CIWG的患病率似乎很低，超过84%的患者超重或肥胖。二甲双胍的使用与12个月内体重和体重增加的发生率显著降低相关。药剂师在教育临床医生和患者二甲双胍对减少CIWG的益处方面至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.