Inconsistent Data Link Antipsychotic Use, Diabetes

Do second-generation antipsychotic medications cause diabetes in children and adolescents? That’s the question a team of researchers based at the Meyers Primary Care Institute of the University of Massachusetts School of Medicine recently sought to assess.

“Numerous case reports and studies have suggested a link between the use of antipsychotic medications and diabetes mellitus, impaired glucose tolerance, and insulin resistance in adult populations, although the evidence has been inconsistent,” said Susan Andrade, Sc.D., a senior research associate at the Meyers Primary Care Institute and a research associate professor of medicine at the University of Massachusetts Medical School, and colleagues. Their results were published in the December 2011 Pediatrics.

In light of dramatic increases in use of second-generation antipsychotics in children and adolescents, Andrade and colleagues evaluated the risk of incident diabetes mellitus associated with the use of these medications in a large diverse cohort of children who had received treatment in a typical clinical practice.

To do so, they conducted a retrospective study using the administrative databases of three health plans participating in the Health Maintenance Organization Research Network. Children aged 5 to 18 who began second-generation antipsychotic therapy from January 2001 through December 2008 were compared with two control groups: nonusers of psychotropic drugs and users of antidepressant medications. “This approach allowed us to select children more likely to be similar to second-generation antipsychotic users in terms of treatment for mental health conditions and the potential for detection/diagnosis of diabetes,” explained the researchers. Diagnoses from inpatient and outpatient records, pharmacy dispensings, and outpatient laboratory results were used to identify incident cases of diabetes.

Looking at information on more than 9,000 children who had received second-generation antipsychotics, and comparing them with more than 38,000 who had received no psychotropics, and more than 26,000 who had received antidepressants, the researchers found their results to be inconsistent.

A total of 57 children were identified as having incident diabetes during the follow-up period. “The findings differed depending on the comparison group and the definition of the outcome of interest,” the researchers noted. “We found a potentially fourfold increased rate of diabetes among children exposed to second-generation antipsychotics in comparison with children not exposed, but no statistically significantly increased rate in comparison with children exposed to antidepressant medication.”

The researchers also noted the existence of previous evidence suggesting that youths receiving second-generation antipsychotics experience adverse changes in body composition and metabolic parameters even after short-term therapy.

Limitations of the present study, including the small number of cases, they said, suggest that additional research is needed to define the nature and magnitude of the diabetes risk associated with second-generation antipsychotic use among children.

The study received funding from the Agency for Healthcare Research and Quality.

An abstract of “Antipsychotic Medication Use Among Children and Risk of Diabetes Mellitus” is posted at http://pediatrics.aappublications.org/content/128/6/1135 .