A 60-year-old woman with clozapine-treated disorganized schizophrenia (hebephrenia) and a past history of drug abuse was referred to our diabetes outpatient clinic for dysregulated type 2 diabetes. The patient had been living in supported housing for 19 years.
Clinical and biochemical data from somatic and psychiatric records covering a 2-year period were obtained. At referral, the patient weighed 89 kg (body mass index, 33.5), and her glycated hemoglobin A1c (HbA1c) level was 10.0%. She was being treated with clozapine (375 mg/day), insulin (44 IU/day, biphasic insulin aspart), metformin (2 g/day), and simvastatin (10 mg/day). We initiated add-on treatment with liraglutide (0.6 mg/day, subcutaneous injection), which was well tolerated, and self-administration was uncomplicated. After 3 weeks, the liraglutide dosage was increased to 1.2 mg/day, and after 8 months it was increased to 1.8 mg/day.
Three months of treatment reduced her HbA1c level to 8.9% and her body weight by 5.1 kg. After 2 years of treatment, her total weight loss was 7.7 kg (an 8.7% body weight reduction) (Figure 1). After 14 months, her HbA1c level was less than 6.5%, and the amount of insulin needed gradually decreased (28 IU/day). The patient’s lifestyle and psychiatric status were stable during the 2-year period (a score of 30 on the Global Assessment of Functioning Scale), without hospital admissions.