Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth
IMPORTANCE The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus. OBJECTIVE To compare the risk of type 2 diabetes in children and youth 6 to 24 years of age for recent initiators of antipsychotic...
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| Veröffentlicht in: | JAMA psychiatry (Chicago, Ill.) Ill.), 2013-10, Vol.70 (10), p.1067-1075 |
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| creator | Bobo, William V Cooper, William O Stein, C. Michael Olfson, Mark Graham, David Daugherty, James Fuchs, D. Catherine Ray, Wayne A |
| description | IMPORTANCE The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus. 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. RESULTS 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 |
| doi_str_mv | 10.1001/jamapsychiatry.2013.2053 |
| format | Article |
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Michael ; Olfson, Mark ; Graham, David ; Daugherty, James ; Fuchs, D. Catherine ; Ray, Wayne A</creator><creatorcontrib>Bobo, William V ; Cooper, William O ; Stein, C. Michael ; Olfson, Mark ; Graham, David ; Daugherty, James ; Fuchs, D. Catherine ; Ray, Wayne A</creatorcontrib><description>IMPORTANCE The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus. 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. RESULTS 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.</description><identifier>ISSN: 2168-622X</identifier><identifier>EISSN: 2168-6238</identifier><identifier>DOI: 10.1001/jamapsychiatry.2013.2053</identifier><identifier>PMID: 23965896</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adolescent ; Antipsychotic Agents - adverse effects ; Biological and medical sciences ; Child ; Child psychology ; Diabetes ; Diabetes Mellitus, Type 2 - chemically induced ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes. Impaired glucose tolerance ; Drug dosages ; Drug therapy ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Humans ; Male ; Medical sciences ; Neuropharmacology ; Pharmacology. Drug treatments ; Psycholeptics: tranquillizer, neuroleptic ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychopharmacology ; Psychotropic drugs ; Psychotropic Drugs - adverse effects ; Retrospective Studies ; Risk Factors ; Tennessee - epidemiology</subject><ispartof>JAMA psychiatry (Chicago, Ill.), 2013-10, Vol.70 (10), p.1067-1075</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Medical Association Oct 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a458t-81c0ac4d5b9b8884f200e47cb3c268f777abde0b772c3506f73a411ba561952d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamapsychiatry/articlepdf/10.1001/jamapsychiatry.2013.2053$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2013.2053$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76232,76235</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27805611$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23965896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bobo, William V</creatorcontrib><creatorcontrib>Cooper, William O</creatorcontrib><creatorcontrib>Stein, C. Michael</creatorcontrib><creatorcontrib>Olfson, Mark</creatorcontrib><creatorcontrib>Graham, David</creatorcontrib><creatorcontrib>Daugherty, James</creatorcontrib><creatorcontrib>Fuchs, D. Catherine</creatorcontrib><creatorcontrib>Ray, Wayne A</creatorcontrib><title>Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth</title><title>JAMA psychiatry (Chicago, Ill.)</title><addtitle>JAMA Psychiatry</addtitle><description>IMPORTANCE The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus. 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. RESULTS 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.</description><subject>Adolescent</subject><subject>Antipsychotic Agents - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child psychology</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - chemically induced</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Neuropharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>Psycholeptics: tranquillizer, neuroleptic</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Psychopharmacology</subject><subject>Psychotropic drugs</subject><subject>Psychotropic Drugs - adverse effects</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Tennessee - epidemiology</subject><issn>2168-622X</issn><issn>2168-6238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtLAzEUhYMotmj_gAsJiOCmNe9klqU-wSJIBV0NmUyGpk5napJZ9N-b2lrRLG6y-M49N-cCADEaYYTw9UIv9Sqszdzp6NcjgjBNhdMD0CdYqKEgVB3u3-StBwYhLFA6CiFG1THoEZoJrjLRB9NxE913tzY6E6BuShjnFr648AHbCs7WKwsJvHG6sNEGOLV17WIXoGvgZO7q0tvmW_TednF-Co4qXQc72N0n4PXudjZ5GD493z9Oxk9DzbiKQ4UN0oaVvMgKpRSrCEKWSVNQQ4SqpJS6KC0qpCSGciQqSTXDuNBc4IyTkp6Aq23flW8_OxtivnTBpNF0Y9su5JgxSjMphUroxT900Xa-SdNtKMQ4ybhIlNpSxrcheFvlK--W2q9zjPJN6vnf1PNN6vkm9SQ93xl0xdKWe-FPxgm43AE6GF1XXjfGhV9OKpT-hRN3tuWS06-9pFikjX4BS2eVpQ</recordid><startdate>20131001</startdate><enddate>20131001</enddate><creator>Bobo, William V</creator><creator>Cooper, William O</creator><creator>Stein, C. Michael</creator><creator>Olfson, Mark</creator><creator>Graham, David</creator><creator>Daugherty, James</creator><creator>Fuchs, D. Catherine</creator><creator>Ray, Wayne A</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20131001</creationdate><title>Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth</title><author>Bobo, William V ; Cooper, William O ; Stein, C. Michael ; Olfson, Mark ; Graham, David ; Daugherty, James ; Fuchs, D. Catherine ; Ray, Wayne A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a458t-81c0ac4d5b9b8884f200e47cb3c268f777abde0b772c3506f73a411ba561952d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Antipsychotic Agents - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child psychology</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - chemically induced</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Neuropharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>Psycholeptics: tranquillizer, neuroleptic</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Psychopharmacology</topic><topic>Psychotropic drugs</topic><topic>Psychotropic Drugs - adverse effects</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Tennessee - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bobo, William V</creatorcontrib><creatorcontrib>Cooper, William O</creatorcontrib><creatorcontrib>Stein, C. Michael</creatorcontrib><creatorcontrib>Olfson, Mark</creatorcontrib><creatorcontrib>Graham, David</creatorcontrib><creatorcontrib>Daugherty, James</creatorcontrib><creatorcontrib>Fuchs, D. Catherine</creatorcontrib><creatorcontrib>Ray, Wayne A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA psychiatry (Chicago, Ill.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bobo, William V</au><au>Cooper, William O</au><au>Stein, C. Michael</au><au>Olfson, Mark</au><au>Graham, David</au><au>Daugherty, James</au><au>Fuchs, D. Catherine</au><au>Ray, Wayne A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth</atitle><jtitle>JAMA psychiatry (Chicago, Ill.)</jtitle><addtitle>JAMA Psychiatry</addtitle><date>2013-10-01</date><risdate>2013</risdate><volume>70</volume><issue>10</issue><spage>1067</spage><epage>1075</epage><pages>1067-1075</pages><issn>2168-622X</issn><eissn>2168-6238</eissn><abstract>IMPORTANCE The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus. 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. RESULTS 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.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>23965896</pmid><doi>10.1001/jamapsychiatry.2013.2053</doi><tpages>9</tpages></addata></record> |
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| subjects | Adolescent Antipsychotic Agents - adverse effects Biological and medical sciences Child Child psychology Diabetes Diabetes Mellitus, Type 2 - chemically induced Diabetes Mellitus, Type 2 - epidemiology Diabetes. Impaired glucose tolerance Drug dosages Drug therapy Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Humans Male Medical sciences Neuropharmacology Pharmacology. Drug treatments Psycholeptics: tranquillizer, neuroleptic Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychopharmacology Psychotropic drugs Psychotropic Drugs - adverse effects Retrospective Studies Risk Factors Tennessee - epidemiology |
| title | Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth |
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