- Antipsychotics are mostly used off-label for young people, for conditions including autism spectrum disorder-related irritability, attention deficit-hyperactivity disorder, anxiety, and sleep disturbances.
- Initiation of antipsychotic medications was linked to an increase in the prevalence of pharmacologically treated type 2 diabetes in youths in a Dutch cohort study.
- Recurrent users had greater and increasingly higher risks of pharmacologically treated type 2 diabetes, but this observed increased risk persisted even among those who used antipsychotics only in the first year they were dispensed.
Initiation of antipsychotic medications, even for short durations, was linked to an increase in the prevalence of pharmacologically treated type 2 diabetes in youths, according to a Dutch cohort study.
Among nearly 90,000 youths taking antipsychotic medications, the annual risk difference increased from 2.47 per 10,000 users in the initiation year to 9.02 per 10,000 users by year 5, reported Ravish Nilish Gangapersad, MSc, of Erasmus University Medical Center in Rotterdam, the Netherlands, and co-authors.
The corresponding change in relative risk was 0.89 (95% CI 0.39-1.39) in year 0, rising to 1.84 (95% CI 1.13-2.55) in year 1, and to 3.25 (95% CI 2.15-4.34) in year 5, they wrote in JAMA Network Open.
Recurrent users had greater and increasingly higher risks of pharmacologically treated type 2 diabetes, with a risk difference of 10.17 per 10,000 antipsychotic users by year 5 (95% CI 6.47-13.87), but this observed increased risk persisted even among those who used antipsychotics only in the first year they were dispensed (4.36, 95% CI 2.23-6.49).
“These findings underscore the need for cautious prescribing, structured metabolic monitoring, and early preventive strategies to limit the long-term health and economic burdens of treatment-emergent [type 2 diabetes] in young people,” Gangapersad and team concluded.
These results aligned with previous studies that found an increased risk of type 2 diabetes in young people, with a two- to threefold higher incidence in patients treated with an antipsychotic compared with unexposed peers.
Antipsychotics are mostly used off-label for young people, for conditions including autism spectrum disorder-related irritability, attention deficit-hyperactivity disorder, anxiety, and sleep disturbances.
Nina Kraguljac, MD, a psychiatrist at the Ohio State University Wexner Medical Center in Columbus who wasn’t involved in the study, told MedPage Today that even if an antipsychotic is stopped, the risk for diabetes remains elevated, which is “really clinically important,” as it highlights the need to think critically about when antipsychotics are indicated and when they aren’t.
For schizophrenia or autism spectrum disorder, which have few treatment alternatives, antipsychotic medications should be prescribed as clinically indicated, Kraguljac said. However, for insomnia or anxiety, she noted that she would be “much more hesitant” to prescribe an antipsychotic to a young person, especially if that person was already at heightened risk for diabetes for other reasons.
That the study compared diabetes risk before and after starting antipsychotics in the same person “makes us really confident that this is actually a medication-induced higher risk of diabetes, rather than just some other factor,” she added.
For this study, the authors relied on data from Statistics Netherlands to track the prevalence of pharmacologically treated type 2 diabetes up to 5 years before and after initiation of antipsychotics among patients ages 0 to 19 years.
They included 89,991 youths who were dispensed at least one antipsychotic prescription between 2006 and 2022. Median age at antipsychotic initiation was 13.6 years, and 62% were males.
Females had greater absolute excess risk of type 2 diabetes versus males by year 5 (risk difference 16.48 vs 5.50 per 10,000 antipsychotic users). Adolescents ages 13 to 19 years had a larger long-term increase in risk compared with children ages 7 to 12 years (year-5 risk difference 14.09 vs 5.47 per 10,000 users).
“The greater cumulative risk among females is consistent with previous reports of higher rates of antipsychotic-induced weight gain and metabolic complications,” Gangapersad and team noted.
The study captured only pharmacologically treated type 2 diabetes and therefore likely underestimated the total occurrence by excluding undiagnosed or lifestyle-managed cases, the authors acknowledged.
Future research could investigate which types of interventions might decrease the risk of diabetes once an antipsychotic is started, Kraguljac said, including use of GLP-1 receptor agonists.
