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Metformin for weight loss in schizophrenia: safe but not a panacea
  1. Cenk Tek1,
  2. Lydia Chwastiak2
  1. 1 Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA; cenk.tek@yale.edu
  2. 2 University of Washington, Seattle, Washington, USA; lchwast@u.washington.edu

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What is already known on this topic?

Obesity and diabetes rates are two to three times higher among patients with schizophrenia than they are for the general population, as reflected by higher morbidity and mortality rates. Weight gain induced by antipsychotic medication is implicated. Metformin is shown to delay diabetes conversion and produce modest weight loss among prediabetic obese patients in the general population.1 It has also been shown to attenuate olanzapine-induced weight gain in patients with first-episode schizophrenia.2

What does this paper add?

  • Jarskog and colleagues conducted the largest double-blind, placebo-controlled trial of metformin for weight loss in overweight, non-diabetic schizophrenia patients.

  • Metformin combined with lifestyle and diet intervention (LS) produced an average 3 kg weight loss, compared to 1 kg in the placebo plus LS group. Of the patients on metformin, 17% lost clinically significant weight, compared with 10% in the placebo group.

  • Metformin was well tolerated by patients, while HbA1c levels (but not insulin or fasting glucose levels) improved more in the metformin group.

Limitations

  • Thirty six per cent of patients received aripiprazole, …

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