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Antipsychotics may increase diabetes risk in children
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Children initiating treatment with second-generation antipsychotics are at increased risk for incident type 2 diabetes, especially among those using antidepressants, according to recent study findings published in JAMA Pediatrics.
“With such vast numbers of children being exposed to these medications, the implications for potential long-lasting harm can be jarring,” David M. Rubin, MD, MSCE, of The Children’s Hospital of Philadelphia, said in a press release.
Rubin and colleagues evaluated U.S. children aged 10 to 18 years enrolled in Medicaid between 2003 and 2007 to determine whether initiation of second-generation antipsychotic treatment is associated with an increased risk for incident type 2 diabetes. Overall, 107,551 second-generation antipsychotic initiators and 1,221,434 noninitiators were evaluated.
The researchers found that compared with noninitiators, the risk for diabetes was increased among initiators (OR = 1.51; 95% CI, 1.35-1.69). There was a 38 per 10,000 children risk for developing diabetes during 20 months for initiators compared with 25 per 10,000 children for noninitiators.
There was an increased risk of 23 per 10,000 children for diabetes among initiators taking an antidepressant and second-generation antipsychotic (OR = 1.94; 95% CI, 1.54-2.44). This risk was not found among initiators who were also using stimulants.
When comparing a reference group of risperidone initiators, researchers found an increased risk for diabetes among those initiating ziprasidone (OR = 1.61; 95% CI, 0.99-2.64) and Abilify (aripiprazole, Otsuka Pharmaceuticals; OR = 1.58; 95% CI, 1.21-2.07) but not for quetiapine fumarate or olanzapine.
“Although these findings should certainly give us pause, we should not reflexively overreact to them,” Rubin said. “Rather, we need to incorporate these new revelations about the risk for diabetes into a more thoughtful consideration of the true risks and benefits of prescribing an antipsychotic to a child. Yes, we should try, by all means possible, to minimize the numbers of children and adolescents exposed to these powerful medications. But for some children in immediate crisis, we must also conceded that the benefit of the antipsychotic for acute management may still outweigh the risk.”
According to the researchers, the treatment strategy should be reviewed by clinicians and families to address challenging behaviors.
“Once a child is on the antipsychotic drug, a plan should be agreed upon and periodically revisited to see whether or not an evidence-based counseling service, such as trauma-focused cognitive therapy, could address underlying emotional trauma, which is often the root cause for the behavior,” Rubin said. “That same periodic review would also seek to transition the child off the antipsychotic as soon as possible, once these problems are more suitably addressed.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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