Psychiatric Prescriptions in the Fight Against Juvenile Diabetes

By: Davidta Brown, Senior Staff Editor

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In August 2013, the results of a yearlong safety study were published in the Journal of American Medical Association (JAMA) Psychiatry.¹ The study, which followed the health status of about 43,000 youths aged 6 to 24, confirmed and built upon a previously noted trend in adults: that the use of second generation (also known as “atypical”) antipsychotics is related to an increased risk of type 2 diabetes.¹ While the use of antipsychotics has been shown to correlate with a twofold increase in the risk of type 2 diabetes in adults, it correlates with a threefold risk increase in the youths under study.¹ The use of antipsychotics in children and young adults has increased dramatically in recent decades. The estimated number of office-based treatments for US youths that involved antipsychotics has jumped from 201,000 in 1993 to 1,224,000 in 2002, making the results of this study rather significant.^2,3 Because antidepressants and antipsychotics are known to have outcomes in children that vary from those seen in adults, the effects of antipsychotics on pediatric type 2 diabetes are worthy of particular interest.¹

The pharmacoepidemiological data in this study were collected from children and young adults in the Tennessee Medicaid system who used antipsychotics for conditions such as bipolar disorder, ADHD, and other various mood disorders over the course of one year.⁴ It is important to note that each participant was being treated for a psychiatric condition for which options other than antipsychotic medications were available.¹

After a year, it was discovered that the individuals who had been treated with antipsychotics instead of matched sample treatments with antidepressants or anti-anxiety medication were three times more likely to develop type 2 diabetes. Risk increase was represented as a hazard ratio of 3.03, using the statistical analysis of 106 recent diagnoses of diabetes among patients during follow-up medical screenings.¹ Furthermore, the risk remained elevated for a full year after the discontinuation of the atypical antipsychotic medication therapy, with a hazard ratio of 2.57 during this time.¹ The risk also seemed to increase with long-term, cumulative doses; the hazard ratio was 3.42 for those receiving doses between 5 and 99 gram equivalents of chlorpromazine, and 5.43 for patients receiving 100g or more.¹ As mentioned, the subjects who had increases in the risk of developing type 2 diabetes had treatment options other than antipsychotics for their conditions, so in their cases, reducing the risk could be as simple as changing their prescription.

While this information seems to suggest the need for limited use or even a contraindication of antipsychotics in pediatric patients, it is important to remember that the study only demonstrates correlation, not causation. The relationship between antipsychotic medications and increased risk of type 2 diabetes is not yet fully understood, but it is possible that the increase in risk is a side effect of the weight gain that is also typically associated with psychiatric treatments.⁵

For now, healthcare providers are advised to closely monitor the weight and glucose levels of young adults and children taking atypical antipsychotics, and to suggest treatment alternatives whenever possible.⁴ The rising prevalence of obesity and type 2 diabetes among pediatric patients has been a source of national debate for some time. With further study, the careful selection of psychiatric medications to avoid increasing the risk of type 2 diabetes may prove to be another weapon in the arsenal against this pervasive foe.

SOURCES:

1. Bobo WV, Cooper WO, Stein C, et al. Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth. JAMA Psychiatry. 2013;70(10):1067-1075.
2. Olfson M, Blanco C, Liu L, et al. National Trends in the Outpatient Treatment of Children and Adolescents With Antipsychotic Drugs. Arch Gen Psychiatry. 2006;63(6):679-685.
3. Crystal S, Olfson M, Huang C, et al. Broadened Use of Atypical Antipsychotics: Safety, Effectiveness, and Policy Challenges. Health Aff. 2009; 28(5):w770-w781.
4. Thompson D. Antipsychotic Drugs May Triple Kids’ Diabetes Risk, Study Suggests. Health Day. 2013 Aug [cited 2013 Aug 30]. Available from: http://www.consumer.healthday.com/kids-health-information-23/child-development-news-124/antipsychotic-drugs-may-raise-diabetes-risk-in-kids-study-says-679459.html
5. Stigler KA, Potenza MN, Posey DJ, et al. Weight gain associated with atypical antipsychotic use in children and adolescents: prevalence, clinical relevance, and management [abstract]. Paediatr Drugs. 2004;6(1):33-44.