A recently published article in JAMA Psychiatry shows a 3-fold increased risk for type 2 diabetes in children treated with antipsychotic medications.

This was a retrospective cohort study involving Tennessee Medicaid program children, ages 6 to 24 years (the upper age of a child as defined by the WHO). 28,858 children with recent initiation of antipsychotic drugs were compared to 14,429 matched controls.

The cohort excluded patients previously diagnosed with diabetes and those with conditions for which antipsychotics are the only generally-recognized therapy – schizophrenia or related psychoses, organic psychoses, autism, mental retardation, Tourette syndrome, or other tic disorders.

The control patients were those receiving psychotropic medications such as lithium, anticonvulsant mood stabilizers, antidepressants, psychostimulants, alpha agonists, or benzodiazepines, all given for appropriate psychiatric indications.

Cohort members had a mean age of 14.5 years and 56% were males. The most frequently recorded psychiatric diagnoses were mood disorders, ADHD, and conduct disorders. 87% were prescribed an atypical antipsychotic drug, most frequently risperidone, quetiapine fumarate, and olanzapine.

In the study cohort, there were an estimated 15.8 additional cases of type 2 diabetes per 10,000 person-years of antipsychotic exposure, or a number-needed-to-harm of 633. Risk was elevated during the first year of antipsychotic use, increased with increasing cumulative dose, and was present for children younger than 18 years of age.

The use of these medications in children is increasing, often for off-label indications, and can be associated with side effects. Canada, Wisconsin, and the American Academy of Child and Adolescent Psychiatry have promulgated helpful guidelines on the appropriate use of these medications in children, referenced below.

Michael Vovakes, MD

References:

Bobo, WV, et al, (2013). Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth. JAMA Psychiatry, doi:10.1001/jamapsychiatry.2013.2053

Practice Parameter for the Use of Atypical Antipsychotic Medications in Children and Adolescents, retrieved from http://www.aacap.org/AACAP/Resources_for_Primary_Care/Practice_Parameters_and_Resource_Centers/Practice_Parameters.aspx

Antipsychotic Drug use in Children and Adolescents—Wisconsin Medicaid and BadgerCare Plus Population, retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=5&ved=0CD4QFjAE&url=http%3A%2F%2Fwww.forwardhealth.wi.gov%2FWIportal%2Ftab%2F42%2Ficscontent%2Fprovider%2Fmedicaid%2Fpharmacy%2Fdur%2Fnewsletters%2FMay2012.pdf.spage&ei=-14mUs7BKYKViQKD7IDgAQ&usg=AFQjCNE8rktft7IyehOL-KHKPd-Srq5vFA

CAMESA (Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children) guidelines retrieved from http://www.camesaguideline.org