Association of Antidepressant Medications With Incident Type 2 Diabetes Among Medicaid-Insured Youths

Burcu, Mehmet; Zito, Julie Magno; Safer, Daniel J.; Magder, Laurence S.; dosReis, Susan; Shaya, Fadia T.; Rosenthal, Geoffrey L.

doi:10.1001/jamapediatrics.2017.2896

Cited by 43 publications

(38 citation statements)

References 44 publications

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“…However, among sexual minority youth, minority stress has been shown to be associated with increased risk for depression, a known risk factor for diabetes. 34 Both long-term use of certain classes of antidepressant medications 35 and symptoms of depression have also been linked to greater type 2 diabetes prevalence among adolescents. 34,36 While our study was strengthened by a national sample compris- identity detected across 20 variables in YRBS.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for diabetes are higher among non-heterosexual US high-school students

et al. 2018

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Low physical activity (PA), high sedentary behavior (SB), and overweight and obesity have been shown to associate with increased Type 2 diabetes risk among adolescents. We investigated PA, SB, and overweight and obesity among Youth Risk Behavior Survey (YRBS) respondents to determine if non-heterosexual youth may be at increased diabetes risk compared to heterosexual youth. Weighted city and state YRBS data were pooled across 44 jurisdictions biennially from 2009 to 2015, resulting in a sample size of 350 673 students. Overall, 88.4% identified as heterosexual, 2.1% as gay or lesbian, 5.7% as bisexual, and 3.7% as unsure. With the exception of lesbian female students, after adjusting for age, race/ethnicity, body mass index, and survey year, all non-heterosexual youth reported significantly fewer days per week of PA compared to their sex-matched heterosexual counterparts. Similarly, compared to heterosexual female youth, bisexual and not sure female youth reported significantly more hours per day of SB. These PA and SB findings remained significant after adjustment for depressive symptoms and in-school bullying among bisexual female youth only. In fully adjusted models, lesbian students were 1.85 times more likely to be overweight and lesbian, bisexual, and not sure female youth were 1.55 to 2.07 times more likely to be obese than heterosexual female students. No significant differences in SB, overweight, or obesity were found among gay, bisexual, or unsure male youth compared to heterosexual male youth. Non-heterosexual youth may be at increased risk for developing type 2 diabetes mellitus compared to heterosexual youth. Future studies should characterize diabetes prevalence among non-heterosexual youth.

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Section: Discussionmentioning

confidence: 99%

Risk factors for diabetes are higher among non-heterosexual US high-school students

et al. 2018

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“…Despite expanded use, controversy plagues the benefit-risk discourse on AD use for youth. Questions persist regarding AD efficacy (4), the 2004 FDA boxed warning and safety concerns for suicidality (5), new questions about long-term use with the risk of weight gain and metabolic disorders (6) and prominent concerns about difficulty to discontinue ADs in long-term users due to a withdrawal syndrome (7). Added to these concerns is the fact that pediatric AD use is largely off-label, that is without adequate evidence that benefits outweigh risks either because of age or the diagnosis and indication selected by the treating physician (8).…”

Section: Introductionmentioning

confidence: 99%

Antidepressant Use in Medicaid-Insured Youth: Trends, Covariates, and Future Research Needs

2020

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Background: Detailed research on long-term antidepressant (AD) trends within a single large US Medicaid population of youth has not heretofore been reported. Methods: Administrative claims data for eight annual timepoints across 28 years (1987-2014) were organized for youth (<20 years old) who were continuously enrolled during each study year in a mid-Atlantic state Medicaid program. Total annual AD prevalence and age-, gender-, race-, eligibility group-, and diagnosis-specific prevalence were formed from bivariate analyses; logistic regression assessed the change in use (2007-2014) adjusted for covariates. AD-polypharmacy data were assessed in 2014. Results: The major findings are: 1) AD use in state Medicaid enrollees grew 14-fold between 1987 and 2014. Data from 2014 revealed significantly increased odds of youth with SSRI/SNRI dispensings compared to 2007 (AOR=1.15 95% CI 1.11-1.19), representing 78% of total AD users. 2) Recent AD increases were greatest for 15-19year olds. 3) AD use in girls passed up AD use in boys for the first time in 2014. 4) In 2014, ADs for foster care (12.7%) were 6 times greater than for their income-eligible Medicaidcounterparts. 5) In 2014, a quarter of AD-medicated youth were diagnosed with a behavior disorder. 6) More than 40 percent of AD medicated youth had >=1 other concomitant psychotropic classes for 60 or more days. Conclusions: Second-generation antidepressant use in Medicaid-insured youth has increased despite growing questions that pediatric AD benefits may not outweigh harms. These patterns support the call for publicly funded, independent investigator-conducted post-marketing outcomes research.

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“…A common approach to this limitation is to consider proxies, which capture the most severe cases (e.g., dementia, cerebrovascular disease, renal or hepatic failure), and then compute a confounder summary score such as the DRS, which can help in controlling for unmeasured confounders . This approach has been used in several studies conducted on U.S. claims databases such as Medicaid, although we cannot fully exclude residual confounding in risk estimation due to unmeasured confounders. Another limitation is that, in France, coding instructions, which require information about events that lead to hospitalizations (e.g., trauma) but not about their etiology (e.g., falls), guide choice of hospital discharge diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Risk of Serious Trauma with Glucose‐Lowering Drugs in Older Persons: A Nested Case–Control Study

Arnaud

Pariente

Bezin

et al. 2018

J American Geriatrics Society

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OBJECTIVES: To assess the risk of hospitalization for trauma associated with use of hypoglycemic glucoselowering drugs (GLDs) in individuals aged 65 and older. DESIGN: Observational, nested, case-control study. SETTING: The Echantillon Généraliste de Bénéficiaires claims database, a 1/97 th representative sample of the population covered by French healthcare insurance. PARTICIPANTS: All persons with a first hospitalization for trauma between 2009 and 2015 were considered as potential cases. They were selected if they had been followed for 365 days or longer at index date, were aged 65 and older, and had no diagnosed cancer. Cases (n=10,743) were matched with up to 10 randomly selected controls on age, sex, and length of follow-up (n=106,629). MEASUREMENTS: GLD exposure was considered globally and according to use of hypoglycemic GLDs alone, nonhypoglycemic GLDs alone, or both types of GLDs. Risk of hospitalization for trauma was estimated using hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Risk of hospitalization for trauma was significantly higher with use of GLDs (HR=1.15, 95% CI=1.08-1.22). Greater risk was found only in individuals treated with hypoglycemic GLDs alone (HR=1.26, 95% CI=1.15-1.38), particularly insulin (HR=1.49, 95% CI=1.32-1.68) and glinides (HR=1.34, 95% CI=1.12-1.61). CONCLUSION: This study highlights the excess risk of serious trauma with the use of insulin and glinides.

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Association of Antidepressant Medications With Incident Type 2 Diabetes Among Medicaid-Insured Youths

Cited by 43 publications

References 44 publications

Risk factors for diabetes are higher among non-heterosexual US high-school students

Risk factors for diabetes are higher among non-heterosexual US high-school students

Antidepressant Use in Medicaid-Insured Youth: Trends, Covariates, and Future Research Needs

Risk of Serious Trauma with Glucose‐Lowering Drugs in Older Persons: A Nested Case–Control Study

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