October 9, 2013
Atypical Antipsychotics Can Triple Type 2 Diabetes Risk in Children, Young Adults

Nashville—Children and young adults who take “atypical” antipsychotic medications such as risperidone, quetiapine, aripiprazol, and olanzapine as much as triple their risk of developing type 2 diabetes within the first year of therapy, according to a new study.

The study, published recently in the journal JAMA Psychiatry, was the first large, well-designed study to look at the risk in children, said senior author Wayne A. Ray, PhD, of Vanderbilt University Medical Center.

The report points out that the majority of prescriptions for the drugs in young people are for nonpsychosis-related mood, attention, or behavioral disorders.

“Because we wanted to address this question of risk for indications for which there were therapeutic alternatives, we deliberately excluded those taking antipsychotics for schizophrenia and other psychoses; thus, our entire sample consisted of patients for whom there were alternatives to antipsychotics,” Ray said.

For the study, researchers examined state-provided, de-identified medical records for TennCare youths ages 6 to 24 from 1996 through 2007. Patients being treated with atypical antipsychotics for attention, behavioral, or mood disorders—numbering nearly 29,000—were compared with a similar group of 14,400 who had been prescribed approved medications for those disorders.

Researchers found that the group taking antipsychotics had triple the risk of developing type 2 diabetes in the following year, with the risk growing as cumulative dosages increased. Even after the medications were stopped, the increased risk persisted for at least a year, they noted.

“Users of antipsychotics had a three-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 authors report. “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 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]), the report adds.

The findings were especially significant because, while type 2 diabetes may be increasing in the young age group, it still remains rare. Of the more than 40,000 youths in this study, 106 ended up being diagnosed and treated for type 2 diabetes, according to the researchers.

“That's why this study had to be so large, in order to detect clinically meaningful differences in the risk of type 2 diabetes, a relatively uncommon, but serious condition for children and youth,” Ray emphasized.

He urged that healthcare providers consider alternatives to antipsychotic use in young people.

“This is particularly important for high-risk children, for example, those with elevated weight,” Ray suggested. “Children should be monitored carefully for metabolic effects predisposing them to diabetes, and use of the drug should be at the lowest possible dose for the shortest possible time.”

U.S. Pharmacist Social Connect