Council, Medicines Control

South African Medical Journal (SAMJ)

Promotion of culturally relevanteducational messages neededComprehensive educational messages are warranted so thatcommunities can adopt lifestyles that prevent the major diseaseburdens, without having to focus on a specific condition. Theeducational messages recommended for most NCDs are thesame: follow the correct diet, be physically active, decreasestress levels, visit a doctor regularly, and screen for theprevention and early detection of disease. However, we have tomodify these efforts taking cultural attitudes into account.Weight loss should not be stressed specifically (especially insub-Saharan Africa); instead overall healthy behaviours shouldbe encouraged. Many NCDs are socially and culturally rooted;until cultural norms related to overnutrition are betterunderstood, emphasis should be placed on eating morenutritious food such as fresh fruits and vegetables, decreasingsalt and sugar intake, and increasing physical activity forenergy expenditure. In addition, existing beliefs about bodyimage need to be revised, using effective strategies. This willonly be possible with a heightened awareness and publichealth mandate for curbing the growing epidemic of NCDsand the risk factor of obesity that fuels it.This project was supported by the National ResearchFoundation, the University of the Western Cape, and the MedicalResearch Council Visiting Distinguished Scientist Programme ofSouth Africa.1. Bradshaw D, Groenewald P, Laubscher R, et al. Initial Burden of Disease Estimate for SouthAfrica, 2000. Cape Town: South African Medical Research Council, 2003. 2. World Health Organization. The World Health Report 2002. Reducing Risks, Promoting HealthyLife. Geneva: WHO, 2002.3. Puoane T, Steyn K, Bradshaw D, et al. Obesity in South Africa: the South Africandemographic and health survey. Obes Res 2002; 10: 1038-1048.4. Mvo Z, Dick J, Steyn K. Perceptions of overweight African women about acceptable bodysize of women and children. Curationis 1999; 22: 27-31. 5. Puoane T, Fourie JM, Shapiro M, Rosling L, Tshaka NC, Oelofse A. ‘Big is beautiful’ — anexploration of urban black women in South Africa. South African Journal of Clinical Nutrition1995 (in press).6. Tsolekile L, Puoane T, Zulu J. ‘You are thin and sick, I’m fat and healthy.’ Paper presented atthe Public Health Association of South Africa Conference. Challenging Health Inequalities;Forging Progressive Partnership for Public Health. Durban, 6 - 8 June 2004.7. Caradas AA, Lambert EV, Charlton KE. An ethnic comparison of eating attitudes andassociated body image concerns in adolescent South African school girls. Human Nutritionand Dietetics 2001; 14: 111-120.SAMJ FORUMApril 2005, Vol. 95, No. 4  SAMJ230The Medicines Control Council alerts all health careprofessionals to new safety information regarding theincreased risk of hyperglycaemia and diabetes mellitus inpatients treated with the atypical antipsychotic medicines,clozapine, olanzepine, quetiapine, risperidone andziprasidone.Epidemiological studies have identified an increased risk oftreatment-emergent metabolic adverse events associated withthe atypical antipsychotic medicines. Lipid abnormalities andweight gain are frequently occurring adverse effectsassociated with the atypical antipsychotics. Abnormalities inglucose metabolism range from hyperglycaemia in patientswith or without previously known diabetes mellitus to casesof ketoacidosis, hyperosmolar coma and death. The background risk of type 2 diabetes mellitus inschizophrenic patients as well as the increasing incidence ofdiabetes mellitus in the general population may beconfounders. Patients with existing diabetes in whomantipsychotic therapy is initiated should be closely monitoredfor worsening of diabetic control.All patients treated with atypical antipsychotic medicinesshould be monitored for symptoms of hyperglycaemia.Fasting blood glucose testing should be done on all patientswho develop symptoms of hyperglycaemia, or who are at riskfor type 2 diabetes. In some cases, hyperglycaemia resolved afterdiscontinuation of the atypical antipsychotic medicine;however, there have been cases in which it has persisteddespite stopping therapy, requiring the prescription of anti-diabetic medication.Please continue reporting all adverse drug reactionsassociated with atypical antipsychotic medicines and othermedicines to the National Adverse Drug Event MonitoringCentre, tel. (021) 447-1618, fax (021) 448-6181.Medicines Control CouncilCape TownReferenceshttp://www.tga.gov.au/adr/aadrb/aadr0406.htm#4http://www.fda.gov/medwatch/SAFETY/2004Melkersson K, Dahl M. Adverse metabolic effects associated with atypical antipsychotics. Drugs2004; 64: 701-723.DRUG ALERTHyperglycaemia and diabetes mellitus associated withatypical antipsychotics340257-228-230-SMJ0405  2/4/05  18:01  Page 230

Hyperglycaemia and diabetes mellitus associated with atypical antipsychotics

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Hyperglycaemia and diabetes mellitus associated with atypical antipsychotics

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South African Medical Journal (SAMJ)