Antipsychotics and the risk of type 2 diabetes mellitus in children and youth

• Published in: JAMA psychiatry (Chicago, Ill.) Vol. 70; no. 10; p. 1067
• Main Authors: Bobo, William V, Cooper, William O, Stein, C Michael, Olfson, Mark, Graham, David, Daugherty, James, Fuchs, D Catherine, Ray, Wayne A
• Format: Journal Article
• Language: English
• Published: United States 01.10.2013
• Subjects: Adolescent; Antipsychotic Agents - adverse effects; Child; Diabetes Mellitus, Type 2 - chemically induced; Diabetes Mellitus, Type 2 - epidemiology; Female; Humans; Male; Psychotropic Drugs - adverse effects; Retrospective Studies; Risk Factors; Tennessee - epidemiology; Tennessee
• ISSN: 2168-6238
• DOI: 10.1001/jamapsychiatry.2013.2053

The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus. To compare the risk of type 2 diabetes in children and youth 6 to 24 years of age for recent initiators of antipsychotic drugs vs propensity score-matched controls who had recently initiated another psychotropic medication. Retrospective cohort study of the Tennessee Medicaid program with 28 858 recent initiators of antipsychotic drugs and 14 429 matched controls. The cohort excluded patients who previously received a diagnosis of diabetes, schizophrenia, or some other condition for which antipsychotics are the only generally recognized therapy. Newly diagnosed diabetes during follow-up, as identified from diagnoses and diabetes medication prescriptions. Users of antipsychotics had a 3-fold increased risk for type 2 diabetes (HR = 3.03 [95% CI = 1.73-5.32]), which was apparent within the first year of follow-up (HR = 2.49 [95% CI = 1.27-4.88]). The risk increased with cumulative dose during follow-up, with HRs of 2.13 (95% CI = 1.06-4.27), 3.42 (95% CI = 1.88-6.24), and 5.43 (95% CI = 2.34-12.61) for respective cumulative doses (gram equivalents of chlorpromazine) of more than 5 g, 5 to 99 g, and 100 g or more (P < .04). The risk remained elevated for up to 1 year following discontinuation of antipsychotic use (HR = 2.57 [95% CI = 1.34-4.91]). When the cohort was restricted to children 6 to 17 years of age, antipsychotic users had more than a 3-fold increased risk of type 2 diabetes (HR = 3.14 [95% CI = 1.50-6.56]), and the risk increased significantly with increasing cumulative dose (P < .03). The risk was increased for use restricted to atypical antipsychotics (HR = 2.89 [95% CI = 1.64-5.10]) or to risperidone (HR = 2.20 [95% CI = 1.14-4.26]). Children and youth prescribed antipsychotics had an increased risk of type 2 diabetes that increased with cumulative dose.