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Type 2 diabetes more common in youth exposed to antipsychotics

Cumulative risk and exposure-adjusted incidences and incidence rate ratios for type 2 diabetes were significantly higher among youth exposed to antipsychotics, compared with unexposed psychiatric controls and healthy controls.

“Cardiometabolic adverse effects of antipsychotics tend to appear faster and to a greater extent in youth than in adults,” Britta Galling, MD, of North Shore-Long Island Jewish Health System, Glen Oaks, New York, and colleagues wrote. “Antipsychotic treatment results in relevant weight gain in a significant proportion of youth. Whether this overall heightened risk of short-term cardiometabolic adverse effects in youth compared with adults is due to developmental differences or because of less prior antipsychotic exposure and lifetime antipsychotic-related weight gain remains debated.”

To assess associations between risk for type 2 diabetes and antipsychotic treatment in youth, researchers conducted a meta-analysis of 13 studies including 185,105 youth exposed to antipsychotics. Participants had a mean age of 14.1 years. Mean follow-up was 1.7 years.

Youth exposed to antipsychotics had a cumulative risk for type 2 diabetes of 5.72 (95% CI, 3.45-9.48; P < .001) per 1,000 patients.

The incidence rate was 3.09 (95% CI, 2.35-3.82; P < .001) cases per 1,000 patient-years.

Antipsychotic-exposed youth had significantly higher cumulative type 2 diabetes risk (OR = 2.58; 95% CI, 1.56-4.24; P < .0001) and incidence rate ratio (IRR = 3.02; 95% CI, 1.71-5.35; P < .0001), compared with healthy controls.

Compared with psychiatric controls not receiving antipsychotics, antipsychotic-exposed youth had significantly higher cumulative type 2 diabetes risk (OR = 2.09; 95% CI, 1.5-2.9; P < .0001) and IRR (1.79; 95% CI, 1.31-2.44; P < .0001).

Multivariable meta-regression analyses of 10 studies indicated greater cumulative type 2 diabetes risk was associated with longer follow-up (P < .001), olanzapine prescription (P < .001) and male sex (P = .002).

Higher type 2 diabetes incidence was associated with second-generation antipsychotic prescription (P ≤ .05) and less autism spectrum disorder diagnosis (P = .048).

“The results of this meta-analysis indicate an association between antipsychotic treatment and increased risk for the development of [type 2 diabetes] in youth. These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” Galling and colleagues wrote. “Antipsychotics should be used judiciously and for the shortest necessary duration. Furthermore, routine and proactive monitoring of cardiovascular risk factors should be enforced when prescribing antipsychotics to youth.” – by Amanda Oldt

Disclosure: Galling reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.