Antipsychotics Raise Risk of Diabetes in Youth

Christoph U. Correll, MD Professor of Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine Hempstead, New York, USA Investigator, Center for Psychiatric Neuroscience Feinstein Institute for Medical Research Manhasset, New York, USA Medical Director, Recognition and Prevention (RAP) Program The Zucker Hillside Hospital, Department of Psychiatry

Dr. Christoph Correll

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MedicalResearch.com Interview with:
Christoph U. Correll, MD
Professor of Psychiatry and Molecular Medicine
Hofstra Northwell School of Medicine
Hempstead, New York, USA
Investigator, Center for Psychiatric Neuroscience
Feinstein Institute for Medical Research
Manhasset, New York,
Medical Director, Recognition and Prevention
The Zucker Hillside Hospital,
Department of Psychiatry 

Medical Research: What is the background for this study?

Dr. Correll: Antipsychotics have been used increasingly for psychotic, but also for many non-psychotic conditions, including for disorders and conditions for which they have not received regulatory approval. Moreover, antipsychotics have been associated with weight gain and abnormalities in blood fat and blood glucose levels. Although data in youth have been less available than in children and adolescents, youth appear to be more sensitive to the cardiometabolic adverse effects of antipsychotics than adults in whom significant weight gain might have already occurred due to long-term prior antipsychotic treatment. Nevertheless, type 2 diabetes, which is related to weight gain, overweight and obesity, seemed to be more common in adults than youth, likely due to the fact that it takes a long time for the body to develop diabetes. Recently, several individual epidemiologic or database studies with sufficient long-term follow-up durations suggested that the type 2 diabetes risk was higher in youth exposed to antipsychotics than healthy control youth and, possibly, even compared to psychiatrically ill patients treated with non-antipsychotic medications. However, a meta-analytic pooling of all available data has not been available to estimate the absolute and relative risk of type 2 diabetes in youth receiving antipsychotic treatment. 

Medical Research: What are the main findings?

Dr. Correll: The main findings of the study that meta-analyzed data from 13 studies with 185,105 youth exposed to antipsychotics (average age 14.1 and 59.5 percent male) are that the absolute rates of type 2 diabetes are fortunately still relatively low, i.e. a cumulative type 2 diabetes  risk of 5.7/1,000 patients and an exposure adjusted incidence rate of 3.1/1,000 patient-years. Nevertheless, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.6 times and three times higher compared with 298,803 healthy controls. Furthermore, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.1 times and 1.8 times higher compared with 1,342,121 psychiatric patients not exposed to antipsychotics. Main modifiable risk factors for type 2 diabetes development in antipsychotic-treated youth were treatment with the antipsychotic olanzapine and longer antipsychotic exposure time.

Medical Research: What should clinicians and patients take away from your report?

Dr. Correll: Type 2 diabetes is a risk when treating youth with antipsychotics, especially long-term. Therefore, antipsychotics should be used judiciously and as for as short a period as necessary and possible. Furthermore, clinicians should routinely and proactively monitor the efficacy and need for ongoing antipsychotic treatment as well as the potential emergence of adverse effects. Specifically, clinicians and patients as well as parents should monitor weight change monthly and fasting blood work for blood sugar and blood lipids should be obtained before starting an antipsychotic, three months later and every 6 months thereafter.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Correll: Further research is needed to identify the specific mechanisms of antipsychotic-related weight gain and development of diabetes in order to either counter these effects or develop medications that do not have this problem. Furthermore, research needs to identify patients who are at particularly high risk for weight gain and diabetes and those who seem to be protected against these antipsychotic-related side effects to help individualize treatment selection. Moreover, research is needed that tests lower-risk pharmacologic and non-pharmacologic interventions that may be used effectively before or instead of an antipsychotic when treating non-psychotic conditions. This need pertains especially to youth presenting with severe mood or behavioral dysregulation, irritability and aggression for whom antipsychotics are used a lot, often without even providing psychosocial treatments.

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Christoph U. Correll, MD (0). Antipsychotics Raise Risk of Diabetes in Youth