Antipsychotics May Raise Type 2 Diabetes Risk

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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 of type 2 diabetes in youth, found a meta-analysis published in JAMA Psychiatry.

Antipsychotic exposure doubled the odds of type 2 diabetes compared to psychiatric youth not taking the drugs and increased the odds 2.6 times compared to healthy youth. The risk increased with longer follow-up, was greater in males and was particularly associated with olanzapine.

A team led by Britta Galling, MD, of Zucker Hillside Hospital in New York, 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 three months. They identified 13 studies with 180,105 youth exposed to antipsychotics. The participants, ranging from 2 to 24 years old 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 of type 2 diabetes was 5.7 per 1,000 patients exposed to antipsychotics, compared to 2.6 of 1,000 unexposed patients found among more than 1.34 million psychiatric controls in seven studies. Among nearly 300,000 healthy controls in eight studies, the risk was 2.2 per 1,000 youth. The incidence rate of type 2 diabetes was 3 per 1,000 patient-years for antipsychotic exposure, 1.7 per 1,000 patient-years for unexposed psychiatric controls and 1.3 per 1,000 patient-years among healthy controls.

The excess risk of type 2 diabetes, then, translated to 3 additional diagnoses for every 1,000 youth receiving antipsychotics. Every 322 psychiatric patients prescribed antipsychotics would result in one excess type 2 diabetes case, whereas the number needed to harm compared to healthy controls was 280. 

Most of the kids taking antipsychotics had been diagnosed with a disruptive behavior disorder, attention deficit/hypeactivity 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

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


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