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Antipsychotic medications increased hyperglycemia hospitalization risk in older patients with diabetes

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Older patients with diabetes who take antipsychotic medications appear to have an increased risk for hospitalization for hyperglycemia, especially soon after initiating therapy.

“Initiation of antipsychotic therapy represents a critical period during which seniors with diabetes are particularly vulnerable to metabolic decompensation,” researchers wrote in Archives of Internal Medicine.

The researchers identified prescription records for 13,817 patients aged 66 years or older. All patients had diabetes and began treatment with antipsychotic medications between April 1, 2002 and March 31, 2006.

Patients were divided into three groups based on treatment strategies: insulin, oral hypoglycemic agents or no treatment. Each patient hospitalized for hyperglycemia was matched with up to 10 age- and gender-matched controls not hospitalized during the same period.

Comparison of medication use

Eleven percent of the cohort was hospitalized for hyperglycemia. Patients who were currently using antipsychotic medications had a higher risk for hyperglycemia compared with controls who had discontinued antipsychotic medications for more than 180 days (OR=1.50). The risk was increased for use of all antipsychotic agents (atypical and typical).

“The risk was particularly high during the initial course of treatment and was increased with the use of all antipsychotic agents,” the researchers wrote. The risk was extremely high even after just one prescription for antipsychotic treatment.

The researchers concluded that further research is needed to assess whether these findings represent a causal effect antipsychotic drug use.

“Case reports of acute hyperglycemia after the initiation of therapy with these drugs suggest that they may also be associated with acute glycemic changes,” they wrote. “In the meantime, other options to manage behavioral symptoms of dementia should be considered among older persons with diabetes.”

Lipscombe LL. Arch Intern Med.2009;169:1282-1289.