Antipsychotics increase type 2 diabetes risk for children and youth

Children and youth on antipsychotics appear to have a 3-fold increased risk for type 2 diabetes mellitus, according to a study published by JAMA Psychiatry.

William V. Bobo, MD, MPH, of the Vanderbilt University School of Medicine, Nashville, oversaw a retrospective cohort study of the Tennessee Medicaid program with 28,858 recent initiators of antipsychotic drugs and 14,429 matched controls. The study found that children and youth aged 6 to 24 years who were prescribed antipsychotic drugs had a 3-fold increased risk of new-onset treated type 2 diabetes, as compared with a matched control group of patients who initiated other psychotropic medications.

Patients who previously received a diagnosis of diabetes, schizophrenia, or some other condition for which antipsychotics are the only generally recognized therapy were excluded.

The control group medications included mood stabilizers (eg, lithium), antidepressants, psychostimulants, ɑ-agonists (with diagnosed attention-deficit/hyperactivity disorder [ADHD] or other behavior/conduct problems), and benzodiazepines (with a psychiatric diagnosis).

Researchers noted 106 incident cases of type 2 diabetes (18.9 cases per 10,000 person-years) during follow-up. The mean age of the patients was 16.7 years and 37% were male.

 Users of antipsychotic drugs was associated with a 3-fold increased risk for type 2 diabetes (hazard ratio [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 remained increased for up to 1 year following discontinuation of antipsychotic use (HR, 2.57), according to the study.

“This study was motivated by reports of increased type 2 diabetes risk associated with some antipsychotic drugs in adults, and clinical studies in youth showing adverse changes in markers of type 2 diabetes risk, such as weight gain, during treatment with some antipsychotics,” Dr Bobo told Formulary.

“Our findings highlight the need for caution when considering antipsychotics for non-primary indications, and to weigh risks and benefits of antipsychotic treatment for every case, factoring in the potential for treatment-emergent type 2 diabetes,” Dr Bobo said. “If antipsychotic treatment is deemed the best option among all reasonable choices, frequently assessing body weight and checking glucose and lipid levels is needed.”