The role of metformin hydrochloride in complex therapy of disorders of carbohydrate metabolism in patients with paranoid schizophrenia treated with atypical antipsychotics
Authors: Romash Ivan 
Published: November 2020

Introduction. According to the literature, mortality among patients with schizophrenia is 1.5 -2 times higher than in the healthy population. One explanation for this is the complication of neuroleptic therapy, which, according to various authors, occurs in 2 to 100% of cases.

Purpose. We aimed to study some indicators of carbohydrate metabolism disorders in patients with paranoid schizophrenia who have been taking neuroleptics for a long time, to correct the established changes by adding metformin hydrochloride to the standard regimen and to monitor its effectiveness.

Methodology. The study was conducted based on Municipal non-commercial enterprise "Precarpathian regional clinical center of mental health of Ivano-Frankivsk regional council. This study included patients diagnosed with paranoid schizophrenia according to the criteria of ICD-10 (F20.0). As a result of our studies in 63 patients, we found a violation of carbohydrate metabolism, which accounted for 52% of all examined. Among them, 55 patients with prediabetes: 12 (19.04%) patients with impaired glucose tolerance (IGT), 43 (68%) with impaired fasting glycemia (IFG), and 8 patients (12.7%) with type 2 diabetes mellitus (T2D). Subsequently, all these 63 patients were prescribed corrective therapy with a drug from the group of biguanides - metformin hydrochloride at a dose from 500 to 1000 mg/day: in violation of IFG at a dose of 500 mg/day; in case of IGT - 850 mg/day; in the case of T2D- 1000 mg/day. All studies were performed before and after 3 months of metformin correction. These included fasting glucose, postprandial hyperglycemia (PPG) (two hours after a meal), glycosylated hemoglobin (HbAIc), immunoreactive insulin (IRI), and, if necessary, an oral glucose tolerance test (OGTT). Fasting plasma glucose (FPG) was measured by the glucose oxidase method. HbAIc values were determined by ion-exchange high-performance liquid chromatography (HPLC). The determination of the IRI level was performed by enzyme-linked immunosorbent assay (ELISA)

Results and Discussion. The results of the research showed that 52% of all surveyed found disorders of carbohydrate metabolism. They were prescribed corrective therapy with a drug from the group of biguanides - metformin hydrochloride at a dose of 500 to 1000 mg/day. As a result of the research, we found that in all groups of examined patients revealed a positive dynamics of carbohydrate metabolism under the influence of this drug. A significantly higher therapeutic effect of the treatment of carbohydrate metabolism disorders with metformin was found in patients receiving the latter in combination with haloperidol. The combination of metformin with risperidone and quetiapine showed a slightly lower clinical effect.

Conclusion. Our own clinical experience gives grounds to recommend metformin hydrochloride as a medium for the correction of carbohydrate metabolism disorders in patients with a paranoid form of schizophrenia in the treatment of this category of patients with neuroleptics