Antipsychotic drug use in children for mood/behavior disorders increases type 2 diabetes risk
by Carole Bartoo | Posted on Thursday, Aug. 22, 2013 — 1:00 PM
Prescribing of “atypical” antipsychotic medications to children and young adults with behavioral problems or mood disorders may put them at unnecessary risk for type 2 diabetes, a Vanderbilt University Medical Center study shows. Young people using medications like risperidone, quetiapine, aripiprazol and olanzapine led to a threefold increased risk of developing type 2 diabetes within the first year of taking the drug, according to the study published Aug. 21 in the journal JAMA Psychiatry.
While other studies have shown an increased risk for type 2 diabetes associated with the use atypical antipsychotic medications, this is the first large, well-designed study to look at the risk in children, said Wayne A. Ray, Ph.D., professor of Preventive Medicine, and senior author of the study. The authors note the use of these drugs for non-psychosis-related mood, attention or behavioral disorders in youth/children now accounts for the majority of prescriptions.
“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.
State-provided, de-identified medical records were examined for TennCare youths ages 6-24 from 1996 through 2007. During that time children and youth who were prescribed treatment with atypical antipsychotics for attention, behavioral or mood disorders, were compared with similar youth prescribed approved medications for those disorders. Even with the further elimination of certain disorders that are commonly associated with diabetes, like polycystic ovarian syndrome, those taking antipsychotics had triple the risk of developing type 2 diabetes in the following year, with the risk increasing further as cumulative dosages increased. The increased risk persisted for at least a year after the medications were stopped.
Ray and his colleagues point out developing type 2 diabetes is still rare in this age group. Of the nearly 29,000 children and youth in the antipsychotic medication group and 14,400 children in the control group, 106 were ultimately diagnosed and treated for type 2 diabetes.
“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 said.
The take-away message for providers, said Ray, is to carefully examine alternatives to antipsychotic use.
“This is particularly important for high-risk children, for example, those with elevated weight. 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,” he said.
The first author of this study is William V. Bobo, M.D., MPH, from the Mayo Clinic. Other Vanderbilt authors included William O. Cooper, M.D., MPH, Cornelius Vanderbilt Professor of Pediatrics and Preventive Medicine; Michael Stein, M.B.Ch.B., Dan May Chair and professor of Medicine and Pharmacology; James Daughtery, M.S. and Catherine Fuchs, M.D. , associate professor of Pediatrics and Psychiatry, along with colleagues from Columbia University and the U.S. Food and Drug Administration.
Further Readings of Interest
Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth
Objective 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.
Design, Setting, and Participants 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.
Main Outcomes and Measures 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]).
Conclusions and Relevance Children and youth prescribed antipsychotics had an increased risk of type 2 diabetes that increased with cumulative dose.