Increased Prevalence of Obesity and Glucose Intolerance in Youth Treated with Second—Generation Antipsychotic Medications

Panagiotopoulos, Constadina; Ronsley, Rebecca; Davidson, Jana

doi:10.1177/070674370905401104

Cited by 60 publications

(45 citation statements)

References 33 publications

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“…Similar to many studies of healthy children, adolescents, and adults, we also found that subjects with type 1 diabetes and with antipsychotic medication had increased weight (8)(9)(10)(11)(12)(13). Interestingly, our survey showed an increased BMI with both typical and atypical antipsychotic treatment.…”

Section: Discussionsupporting

confidence: 69%

“…In addition to the extrapyramidal symptoms caused by typical antipsychotics, the adverse metabolic effects of atypical antipsychotics are of concern (8)(9)(10)(11)(12)(13)(14). The use of atypical antipsychotics may result in weight gain, changes in lipid concentrations, increased glucose concentrations, and insulin resistance in healthy subjects (8)(9)(10)(11)(12)(13)(14). Weight gain occurs in up to 50% of patients receiving longterm treatment for schizophrenia (8).…”

mentioning

confidence: 99%

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Comparison of Glycemic and Metabolic Control in Youth With Type 1 Diabetes With and Without Antipsychotic Medication: Analysis From the Nationwide German/Austrian Diabetes Survey (DPV)

et al. 2015

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OBJECTIVEThe objective of this study was to explore metabolic risk factors and glycemic control in youth with type 1 diabetes treated with typical or atypical antipsychotics. RESEARCH DESIGN AND METHODSData for 60,162 subjects with type 1 diabetes up to the age of 25 years registered in the nationwide German/Austrian Diabetes Survey were included in the analysis. BMI; HbA 1c ; treatment strategy; prevalence of hypertension, dyslipidemia, microalbuminuria, and retinopathy; frequency of hypoglycemia and diabetic ketoacidosis (DKA); and immigrant status among subjects treated with typical or atypical antipsychotics were compared with those without antipsychotic medication and analyzed by regression analysis. RESULTSA total of 291 subjects with type 1 diabetes (median diabetes duration 7.2 years) received antipsychotic medications (most commonly risperidone). Subjects treated with antipsychotics had a higher BMI (P = 0.004) and dyslipidemia was more frequent (P = 0.045) compared with subjects not receiving antipsychotic medication. Frequencies of severe hypoglycemia and DKA were significantly higher in subjects receiving antipsychotics (P < 0.001). The prevalences of hypertension, microalbuminuria, and retinopathy were not different. In subjects treated with typical antipsychotics, glycemic control did not differ compared with those who did not receive antipsychotic medications. By contrast, subjects treated with atypical antipsychotics had higher HbA 1c levels (P = 0.022). CONCLUSIONSThis analysis from a real-life survey demonstrated that subjects with antipsychotic medication had worse glycemic control and a higher rate of acute complications compared with those without antipsychotic medication. Health care teams caring for youth with type 1 diabetes taking antipsychotic medication need to know about these findings. We suggest monitoring metabolic risk factors as well as providing diabetes education about prevention of acute complications.

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Section: Discussionsupporting

confidence: 69%

mentioning

confidence: 99%

Comparison of Glycemic and Metabolic Control in Youth With Type 1 Diabetes With and Without Antipsychotic Medication: Analysis From the Nationwide German/Austrian Diabetes Survey (DPV)

et al. 2015

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“…Subjects were divided into patients (SGAtreated for at least 7 days) and control subjects (SGA-naive on admission and never previously exposed to an SGA). Based on previous literature, 23,28,[41][42][43][44][45][46][47][48] a limited number of pre-specified demographic and clinical characteristics of the groups (see rationale provided for the logistic regression below) were selected, a priori, and compared, using 2-tailed, independent samples t tests, and the remaining data are presented descriptively to limit alpha-type error. Where the data were not normally distributed, Mann-Whitney U tests were performed.…”

Section: Discussionmentioning

confidence: 99%

“…As part of a quality assurance initiative in response to findings demonstrating low levels (27% to 39%) of metabolic monitoring, 28 the CAPE Unit implemented a metabolic monitoring protocol 3 in January 2008. Because SGA-naive children presenting to the CAPE Unit have a high risk (95.4 %) of being started or recommended to start an SGA, either at some point during the admission or in follow-up, monitoring was recommended for all children on admission, regardless of treatment status.…”

Section: Study Proceduresmentioning

confidence: 99%

“…27 Using a cross-sectional retrospective study design, we recently demonstrated that SGA treatment was associated with a 2-fold higher prevalence rate of obesity and a 3-fold higher prevalence rate of IFG in SGA-treated, compared with SGA-naive, children. 28 Given that population-based studies in children have demonstrated that obesity confers increased risk for the MetS, 20 we hypothesized that children treated with SGAs for a longer duration would have an increased risk for MetS and its components. Therefore, the primary objective of our study was to assess the crosssectional prevalence of MetS and its components, as well as predictors for MetS, in a group of children with a longer duration of SGA exposure.…”

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confidence: 99%

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Waist Circumference is a Sensitive Screening Tool for Assessment of Metabolic Syndrome Risk in Children Treated with Second-Generation Antipsychotics

et al. 2012

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Objective:To compare the prevalence of metabolic syndrome (MetS) and its components in second-generation antipsychotic (SGA)-treated and SGA-naive children; and to explore the utility of clinical markers, such as waist circumference (WC) and body mass index (BMI), as screening tools for MetS.Methods: Subjects were prospectively recruited from the Psychiatry Emergency Unit at British Columbia Children's Hospital. As part of a quality-assurance project, a metabolic monitoring protocol was implemented, including collection of anthropomorphic and laboratory data.Results: From January 2008 to February 2010, there were 117 SGA-treated and 217 SGA-naive children recruited. The overall prevalence of MetS was 19.0% (16/84; median treatment duration = 14 months) in SGA-treated and 0.8% (1/127) in SGA-naive children (OR 29.7; 95% CI 3.85 to 228.40, P < 0.001), with an increased prevalence of all components except high-density lipoprotein cholesterol (HDL-C), respectively: elevated WC (40.7% and 10.1%; P < 0.001); hypertriglyceridemia (33.7% and 18.8%; P = 0.01); impaired fasting glucose (12.5% and 0.7%; P = 0.005); and elevated blood pressure (41.2% and 16.5%; P < 0.001). SGA treatment was the strongest predictor of MetS (OR 19.2; 95% CI 2.30 to 160.44, P = 0.006) followed by male sex (OR 5.7; 95% CI 1.08 to 30.62, P = 0.04). Presence of abdominal obesity was more sensitive (92.9%) than BMI (68.8%), while fasting glucose of 5.6 mmol/L or more and HDL-C of 1.03mmol/L or less were most specific (94.1%) in correctly identifying MetS.Conclusions: SGA treatment confers a significantly increased risk for MetS over the long term. WC measurement is a simple and sensitive screening tool for determining MetS risk in SGA-treated children. These data highlight the dangers of SGA treatment and the importance of standardized metabolic monitoring using sex-and age-adjusted tables in this population.

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Risk for Incident Diabetes Mellitus Following Initiation of Second-Generation Antipsychotics Among Medicaid-Enrolled Youths

et al. 2015

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IMPORTANCE Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children, either singly or in a medication combination. Although metabolic adverse effects have been linked to SGA use in youths, estimating the risk for type 2 diabetes mellitus, a rarer outcome, has been challenging.OBJECTIVE To determine whether SGA initiation was associated with an increased risk for incident type 2 diabetes mellitus. Secondary analyses examined the risk associated with multiple-drug regimens, including stimulants and antidepressants, as well as individual SGAs. DESIGN, SETTING, AND PARTICIPANTSRetrospective national cohort study of Medicaid-enrolled youths between January 2003 and December 2007. In this observational study using national Medicaid Analytic eXtract data files, initiators and noninitiators of SGAs were identified in each month. Included in this study were US youths aged 10 to 18 years with a mental health diagnosis and enrolled in a Medicaid fee-for-service arrangement during the study. Those with chronic steroid exposure, a diagnosis of diabetes mellitus, or SGA use during a 1-year look-back period were ineligible. The mean follow-up time for all participants was 17.2 months. Youths were followed up until diagnosis of diabetes mellitus or end of follow-up owing to censoring caused by the transition into a Medicaid managed care arrangement or Medicaid ineligibility (the end of available data). Propensity weights were developed to balance observed demographic and clinical characteristics between exposure groups. Discrete failure time models were fitted using weighted logistic regression to estimate the risk for incident diabetes mellitus between initiators and noninitiators. EXPOSURE A filled SGA prescription. MAIN OUTCOMES AND MEASURESIncident type 2 diabetes mellitus identified through visit and pharmacy claims during the observation period. RESULTS Among 107 551 SGA initiators and 1 221 434 noninitiators, the risk for incident diabetes mellitus was increased among initiators (odds ratio [OR], 1.51; 95% CI, 1.35-1.69; P < .001). Compared with youths initiating only SGAs, the risk was higher among SGA initiators who used antidepressants concomitantly at the time of SGA initiation (OR, 1.54; 95% CI, 1.17-2.03; P = .002) but was not significantly different for SGA initiators who were concomitantly using stimulants. As compared with a reference group of risperidone initiators, the risk was higher among those initiating ziprasidone (OR, 1.61; 95% CI, 0.99-2.64; P = .06) and aripiprazole (OR, 1.58; 95% CI, 1.21-2.07; P = .001) but not quetiapine fumarate or olanzapine. CONCLUSIONS AND RELEVANCEThe risk for incident type 2 diabetes mellitus was increased among youths initiating SGAs and was highest in those concomitantly using antidepressants. Compared with risperidone, newer antipsychotics were not associated with decreased risk.

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Increased Prevalence of Obesity and Glucose Intolerance in Youth Treated with Second—Generation Antipsychotic Medications

Cited by 60 publications

References 33 publications

Comparison of Glycemic and Metabolic Control in Youth With Type 1 Diabetes With and Without Antipsychotic Medication: Analysis From the Nationwide German/Austrian Diabetes Survey (DPV)

Comparison of Glycemic and Metabolic Control in Youth With Type 1 Diabetes With and Without Antipsychotic Medication: Analysis From the Nationwide German/Austrian Diabetes Survey (DPV)

Waist Circumference is a Sensitive Screening Tool for Assessment of Metabolic Syndrome Risk in Children Treated with Second-Generation Antipsychotics

Risk for Incident Diabetes Mellitus Following Initiation of Second-Generation Antipsychotics Among Medicaid-Enrolled Youths

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