Hempstead, NY—Antipsychotic treatment appears to increase the risk of developing type 2 diabetes for young patients, according to a new study.
The report, published online by JAMA Psychiatry, suggests the condition is relatively rare, however, with small absolute incidence rates. On the other hand, the study notes that antipsychotics, particularly second-generation antipsychotics (SGAs), are used increasingly in young patients for a variety psychiatric disorders, broadening the population exposed to the risks.
The meta-analysis led by Hofstra Northwell School of Medicine researchers included 13 studies with 185,105 patients—the majority male with an average age of 14.1—exposed to antipsychotics.
After a mean follow-up of 1.7 years, the cumulative risk of type 2 diabetes was found to be 2.6 times higher than healthy controls, with an incident rate per patient year at three times higher. Compared to psychiatric patients not using antipsychotics, the cumulative rate was 2.1 times higher and the incidence rate per patient year was 1.8 times higher in those using the drugs.
Study authors emphasize that cardio-metabolic adverse effects of antipsychotics tend to appear faster and to a greater extent in youth than in adults, especially weight gain.
“Whether this overall heightened risk of short-term cardio-metabolic adverse effects in youth compared with adults is due to developmental differences or because of less prior antipsychotic exposure and lifetime antipsychotic-related weight gain remains debated,” they point out.
The study also suggests that unhealthy lifestyle behaviors and other pharmacologic treatments associated with psychiatric disorders are contributors to the risk of weight gain or obesity, metabolic abnormalities, and type 2 diabetes.
In this review, further analysis of 10 studies determined that greater cumulative type 2 diabetes risk was associated with longer follow-up, olanzapine prescription, and male sex. A higher rate of incidence of the disease appeared to be linked to second-generation antipsychotic prescriptions as well as a lower rate of autism spectrum disorder diagnosis.
Growing use of the drugs has made even small increases in risks more significant, according to the researchers, who note that antipsychotic use in youth once was restricted to schizophrenia spectrum disorders. Now, however, “significant data for SGA efficacy” have accumulated for nonpsychotic disorders, leading to regulatory approval for bipolar mania and irritability associated with autistic disorder and Tourette syndrome, they add.
In addition, according to background information in the study, “antipsychotic use in youth has broadened substantially to many off-label indications, including impulsivity, mood dysregulation, aggressive behaviors, depression, and anxiety.”
“Olanzapine treatment and antipsychotic exposure time were the main modifiable risk factors for T2DM development in antipsychotic-exposed youth,” the authors write. “Antipsychotics should be used judiciously and for the shortest necessary duration, and their efficacy and safety should be monitored proactively.”
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