Diabetes Risk in Kids Tied to Antipsychotic Meds

Type 2 diabetes risk increased for kids and teens after taking antipsychotic medications

(RxWiki News) Medications used to treat mental health disorders can have serious side effects. Researchers wanted to know if these medications could lead to weight gain and increased diabetes risk in children and teens like they do in adults.

A recent study looked at a large group of children and teenagers who had been prescribed antipsychotic medications for certain mental health conditions.

The study results showed that rates of type 2 diabetes were higher in those who were prescribed antipsychotic medications compared to those prescribed other psychotropic medications.

"Discuss side effect risks with a pharmacist."

William V. Bobo, MD, MPH, from the Department of Psychiatry at Vanderbilt University, worked with a team of researchers to study the potential risk for kids and teens of developing diabetes after taking antipsychotic medications for mental health conditions.

Previous research has suggested that antipsychotic medications may increase an adult's risk for developing type 2 diabetes.

Antipsychotic medications may be used to treat schizophrenia, bipolar disorder and other psychotic disorders.

Certain antipsychotic medications have been shown to cause spikes in weight gain, blood sugar and insulin resistance. Insulin is a hormone involved in regulating blood sugar.

If left uncontrolled, the combination of weight gain, blood sugar and insulin resistance can lead to type 2 diabetes.

For this study, the researchers looked through Tennessee’s Medicaid records for patients, ages 6 to 24, taking antipsychotic medications from 1996 to 2007.

The researchers identified 28,858 patients who had recently started taking an antipsychotic. The majority of patients (87 percent) were taking atypical antipsychotics.

The researchers did exclude patients who were taking antipsychotics for conditions where no other medication was available, such as schizophrenia. 

Atypical antipsychotics are second generation antipsychotics, such as quetiapine (brand name Seroquel), risperidone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril), aripiprazole (Abilify) and ziprasidone (Geodon).

The researchers also included 14,429 age- and gender-matched patients who were not taking antipsychotics, but were taking other types of medications for mental health conditions.

Patients who had been previously diagnosed with diabetes were excluded from the study.

Patients who had been taking antipsychotic medications for longer than 90 days were also excluded from the study unless they had not been taking the medication for a full year prior to starting again in the previous 90 days.

Overall, 106 people in the entire study developed type 2 diabetes. Among those who developed diabetes, 92 were taking antipsychotics and 14 were taking other psychotropic medications.

The results of the study showed that antipsychotic use tripled the risk of developing type 2 diabetes. The majority of patients who developed type 2 diabetes did so within the first year of taking antipsychotic medications.

As the doses of antipsychotic medication increased, the risk of developing type 2 diabetes increased. 

The researchers found only a very minor increase in risk (13 percent) for developing type 1 diabetes after taking antipsychotics.

The risk for developing diabetes was still present until up to one year after stopping antipsychotic use.

When the researchers excluded patients ages 18 and older, the risk of developing type 2 diabetes while taking antipsychotics was still three times greater compared to the risk for people not taking antipsychotic medications.

The study authors concluded that taking an antipsychotic medication increased the risk of developing type 2 diabetes in children and teens.

"Antipsychotic use in children and adolescents has been on the rise, particularly the use of the newer atypical antipsychotics such as risperidone. Indications for which antipsychotics are prescribed for individuals in this group include bipolar disorder, schizophrenia and irritability associated with autism," Jason Poquette, BPharm, RPh, a practicing pharmacist who was not involved with the study, told dailyRx News in an interview.

"The results of this study serve to raise the awareness of the risk of type II diabetes when these medications are prescribed. Physicians and pharmacists need to be vigilant in monitoring for the development of type II diabetes in these patients, as well as providing dietary support when necessary," Dr. Poquette said. 

"This study also highlights the need for more research into possible variations between the antipsychotics in terms of their potential to be associated with diabetes. As a pharmacist, I encourage and help patients to think through possible risks associated with taking medications and make more informed choices about the medication therapy they choose, particularly when it involves their children," Dr. Poquette continued. 

"Children who take antipsychotic medications can develop any type of diabetes: type I diabetes, type II diabetes or diabetes secondary to the medication itself. A careful evaluation by a pediatric endocrinologist can determine both the type of diabetes and direct treatment," Kathleen C. Moltz, MD, FAAP, Pediatric Endocrinologist and Director of Pediatric Diabetes Services on staff at DMC Children's Hospital of Michigan, told dailyRx in an email. 

"Some children may be changed to a different psychiatric medication or medication class and have complete resolution of hyperglycemia. Other children will need to take oral medication such as metformin. Some children will need to take insulin once or more a day. A full diabetes team can also provide medical nutrition therapy, educate regarding diabetes and home blood glucose monitoring, and provide support for the child and family," continued Dr. Moltz, who was not involved with this study. 

This study was published in August in JAMA Psychiatry.

The Agency for Healthcare Research and Quality and the Centers for Education and Research on therapeutics provided funding for this project. Dr. Bobo reported financial relationships with Cephalon, Janssen Pharmaceutica and Pfizer. Dr. Olfson reported indirect financial relationships with Eli Lilly, Bristol-Myers Squibb.

Review Date: 
August 20, 2013