Type 2 Diabetes Risk Up With Antipsychotics

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The risk increased with longer follow-up, was greater in males and was particularly associated with olanzapine.
The risk increased with longer follow-up, was greater in males and was particularly associated with olanzapine.

Taking antipsychotics increases risk for type 2 diabetes in youth, found a meta-analysis published in JAMA Psychiatry.

The odds of developing type 2 diabetes were twice as high in children exposed to antipsychotics as compared with those not taking the drugs, and 2.6 times higher as compared with healthy children. The risk increased with longer follow-up, was greater in boys, and was particularly associated with olanzapine.

Britta Galling, MD, of Zucker Hillside Hospital in New York, and colleagues combed PubMed and PsychINFO databases for all longitudinal studies through May 4, 2015, that investigated type 2 diabetes incidence among youth taking antipsychotics for at least 3 months. They identified 13 studies with 180 105 youth exposed to antipsychotics. The participants, ranging from 2 to 24 years of age with an average age of 14 years, were tracked for an average 1.7 years and a total of 310 438 patient-years.

Before adjustments, overall risk for type 2 diabetes was 5.7 per 1000 patients exposed to antipsychotics, compared with 2.6 of 1000 unexposed patients found among more than 1.34 million psychiatric controls in 7 studies. 

Among nearly 300 000 healthy controls in 8 studies, the risk was 2.2 per 1000 youth. The incidence rate of type 2 diabetes was 3 per 1000 patient-years for antipsychotic exposure, 1.7 per 1000 patient-years for unexposed psychiatric controls, and 1.3 per 1000 patient-years among healthy controls.

The excess risk for type 2 diabetes, then, translated to 3 additional diagnoses for every 1000 youth receiving antipsychotics. Every 322 psychiatric patients prescribed antipsychotics would result in 1 excess type 2 diabetes case, whereas the number needed to harm compared with healthy controls was 280. 

Most of the kids taking antipsychotics had been diagnosed with a disruptive behavior disorder, attention deficit/hyperactivity disorder, depression, bipolar disorder or another mood disorder. Anxiety, psychosis, autism, substance abuse disorders and tic disorders were less common. 

The vast majority of youth (95%) received second-generation antipsychotics, and in the 10 studies with more specific data, risperidone (Risperdal) comprised 42% of prescriptions, followed by quetiapine fumarate (Seroquel) (27%), aripiprazole (Abilify) (17%) and olanzapine (Zyprexa) (10%).

“The relevance of our findings is further underscored by the fact that type 2 diabetes mellitus is only the most severe outcome of an interplay between antipsychotic exposure and genetic and lifestyle factors that lead to obesity and insulin resistance, which in and of themselves have serious health risks, especially when starting early in life,” the authors noted.

Reference

  1. Galling B, Roldán A, Nielsen RE, et al.Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics. JAMA Psychiatry. 2016;doi:10.1001/jamapsychiatry.2015.2923.
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