chotics. Data from pharmacovigilance studies suggest that a significant propor- tion of recent-onset cases of diabetes can be reversed. Recent Belgian guidelines for screening and monitoring patients treated with antipsychotics propose a switch to an antipsychotic with a safer metabolic profile, but this strategy has not been eval- uated systematically (3). We have recently reported on five pa- tients with treatment-emergent diabetes who were successfully switched to a more suitable antipsychotic, which resulted in the reversal of diabetes (to risperidone in one patient [4] and amisulpride in four patients [5]). Since aripiprazole, a sec- ond-generation antipsychotic agent de- scribed as having a good metabolic profile (6 – 8), became available on the Belgian market, all consecutive patients with re- cently detected diabetes were switched to this agent. Over the last year, a switch to aripi- prazole was initiated in seven consecutive patients (mean age [SD] 37  14 years) after diabetes was detected and confirmed during their previous antipsychotic treat- ment. All patients underwent an extensive metabolic evaluation, including an oral glucose tolerance test (OGTT) at baseline and 6 weeks and 3 months of follow-up. All but two were treated with antipsy- chotic medication for 1 year. One pa- tient was switched from a first-generation antipsychotic, one from clozapine, one from olanzapine, two from quetiapine, and two from risperidone. All cases of diabetes met criteria at 120 min in the OGTT. Two patients also met criteria for diabetes while fasting, and all others had impaired fasting glucose (fasting glucose between 100 and 125 mg/dl). All cases of recent-onset diabetes were reversed at 3 months of follow-up. Six patients had normal glucose values both in the fasting state and at 120 min in the OGTT. One patient had impaired glu- cose tolerance (glucose at 120 min be- tween 140 and 200 mg/dl) at end point. There was a significant reduction in all glucose values in the OGTT, fasting insu- lin, in the homeostasis model assessment of insulin resistance, and in HbA 1c gly- cated hemoglobin, weight, waist circum- ference, and BMI (online appendix [available at http://care.diabetesjournals. org]). Whether this reversibility was due to stopping the prior antipsychotic alone could not be evaluated. Although patients were included prospectively, the number of patients remains limited. The duration of the study was only 3 months, so the observed favorable evolution on meta- bolic parameters should be confirmed over a longer period of time. Future re- search should address these issues more specifically in large, multisite samples. To our knowledge, this is the first prospective case series addressing the metabolic safety of aripiprazole using an extensive metabolic evaluation in pa- tients with recently detected antipsy- chotic treatment– emergent diabetes. If during treatment with an antipsychotic severe metabolic abnormalities emerge, a switch to a safer metabolic agent should be considered as the first treatment option if acceptable for the patient. MARC DE HERT, MD, PHD 1 LINDA HANSSENS, MS, MSPH 2 RUUD VAN WINKEL, MD 1 MARTIEN WAMPERS, PHD 1 DOMINIQUE VAN EYCK, MD 1 ANDRE SCHEEN, MD, PHD 3 JOSEPH PEUSKENS, MD, PHD 1 From the 1 University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium; the 2 De- partment of Epidemiology and Public Health, Uni- versity of Liege, Liege, Belgium; and the 3 Division of Diabetes, Nutrition and Metabolic Disorders, Fac- ulty of Medicine, University Liege, Liege, Belgium. Address correspondence to Marc De Hert, Leu- vense Steenweg 517, 3070 Kortenberg, Belgium. E- mail: marc.de.hert@uc-kortenberg.be. Additional information for this article can be found in an online appendix at http://care. diabetesjournals.org. DOI: 10.2337/dc-06-1393 © 2006 by the American Diabetes Association. ●●●●●●●●●●●●●●●●●●●●●●● References 1. American Diabetes Association: Diagnosis and classification of diabetes mellitus (Po- sition Statement). Diabetes Care 29 (Suppl. 1):S43–S48, 2006 2. American Diabetes Association, American Psychiatric Association, American Associ- ation of Clinical Endocrinologists, North American Association for the Study of Obesity: Consensus development confer- ence on antipsychotic drugs and obesity and diabetes (Consensus Statement). Di- abetes Care 27:596 – 601, 2004 3. De Hert M, Van Eyck D, De Nayer A: Met- abolic abnormalities associated with sec- ond generation antipsychotics: fact or fiction? Development of guidelines for screening and monitoring. Int Clin Psycho- pharmacol 21 (Suppl. 2):11–15, 2006 4. Peuskens H, De Hert M, Van Eyck D, Peu- skens J: A case of reversible olanzapine- induced diabetes after switching to risperidone. Adv Schiz Clin Psych 1:31–33, 2004 5. De Hert M, Van Eyck D, Hanssens L, Wampers M, Scheen A, Peuskens J: Rapid diabetes onset and its reversal among patients treated with second generation antipsychotics (Abstract). Eur Neuropsycho- pharmacol 15 (Suppl. 3):S483, 2005 6. McQuade RD, Stock E, Marcus R, Jody D, Gharbia NA, Vanveggel S, Archibald D, Carson WH: A comparison of weight change during treatment with olanzapine or aripiprazole: results from a random- ized, double-blind study. J Clin Psychiatry 65 (Suppl. 18):47–56, 2004 7. DeLeon A, Patel NC, Crismon ML: Aripi- prazole: a comprehensive review of its pharmacology, clinical efficacy, and toler- ability. Clin Ther 26:649 – 666, 2004 8. L’Italien G, Casey D, Ray S, Carson W, Marcus RN: Comparison of metabolic syndrome incidence among schizophre- nia patients treated with aripiprazole versus olanzapine or placebo. J Clin Psy- chiatry. In press Ovarian Stockpiling in Polycystic Ovary Syndrome, Infertility, and the Combined Use of Rosiglitazone and Metformin W e read with interest the recent re- port by Vaughan and Bell (1), in which the addition of rosiglita- zone to metformin to control glycemia in their 46-year-old patient of Euroasian de- cent resulted in an unplanned and unex- pected, yet successful, pregnancy. This case is another anecdote for the potential usefulness of the glitazone class of drugs in treating the infertility of women with polycystic ovary syndrome (PCOS). We recently encountered a similar sit- uation in a woman in her 40s with a long- standing history of primary infertility due to PCOS. Her PCOS has been extensively, but ineffectively, managed since her early 20s, to the extent that she gave up hope of having children when she reached her mid-30s. She developed type 2 diabetes when she was 37 years of age, and after the addition of rosiglitazone to metformin to improve glycemia, she had an unex- pected, successful pregnancy, giving birth to viable healthy twin males. This case adds to the recent accumu- lating scientific usefulness of the combi- nation of metformin and the glitazone class of drugs for improving the metabolic L E T T E R S 2330 DIABETES CARE, VOLUME 29, NUMBER 10, OCTOBER 2006