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Antipsychotics and Diabetes: An Age-Related Association

Clinical Pharmacist, Department of Pharmacy and Pharmacology, Clalit Health Services, Tel-Aviv, Israel

Jacob Dreiher, MD MPH

Epidemiology Consultant, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel

Shmuel H Klang, PhD

Director, Department of Pharmacy and Pharmacology, Clalit Health Services

Hanan Munitz, MBBS MRCPSYCH

Psychiatric Consultant, Clalit Health Services

Arnon D Cohen, MD MPH

Director, Research and Health Planning Department, Health Planning and Policy Wing, Clalit Health Services

Margalit Goldfracht, MD

Director, Department of Quality Improvement, Medicine Division, Community Section, Clalit Health Service

Reprints: Dr. Dreiher, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University, PO Box 653, Beer-Sheva 84150, Israel, fax 972-8-6259238, jacod{at}bgu.ac.il

BACKGROUND: Previous studies have reported an association between anti-psychotic medications and diabetes.

OBJECTIVE: To explore the association between antipsychotic medications and diabetes in patients of different ages.

METHODS: A retrospective analysis of a large health maintenance organization's drug claim database (3.7 million members) was performed. All patients treated with antipsychotic drugs during 1998–2004 were identified. Patients with diabetes were defined by a record of antidiabetic drug use during 2004. The prevalence of diabetes in different age groups treated with antipsychotics was compared with the prevalence of diabetes among enrollees in the same age groups not treated with antipsychotics.

RESULTS: Among 82,754 patients treated with antipsychotics, the association between diabetes and consumption of antipsychotics was strongest in the younger age groups and decreased with increasing age: for patients aged 0–24 years, OR 8.9 (95% CI 7.0 to 11.3); 25–44 years, OR 4.2 (95% CI 3.8 to 4.5); 45–54 years, OR 1.9 (95% CI 1.8 to 2.1); 55–64 years, OR 1.3 (95% CI 1.2 to 1.4); and 65 years or older, OR 0.93 (95% CI 0.9 to 1.0). However, the risk associated with atypical antipsychotics was lower than the risk associated with typical antipsychotics, with ORs ranging from 0.7 in patients 0–24 years old to 0.3 in those 65 years or older.

CONCLUSIONS: Antipsychotic drug use was associated with diabetes mellitus. This association was stronger in younger patients. In older adults, the difference was much smaller and, in some cases, there was no association. A lower risk was associated with atypical agents, as compared with typical antipsychotics. Clinicians should be aware that young adults treated with antipsychotics are at increased risk for diabetes.

Key Words: antipsychotics, diabetes, neuroleptics, pharmacoepidemiology, psychosis, schizophrenia

Published Online, July 29, 2008. www.theannals.com, DOI 10.1345/aph.1L015