Antipsychotic drugs tied to diabetes

Antipsychotic drug therapy of bipolar disorder, autism and other mental disorders in children may come with an increased risk of diabetes, a new study suggests.

Previous research has linked second-generation antipsychotics to an increased risk of diabetes in adults. And there's been some evidence that the drugs can cause weight gain in children.

The new findings, published online in Paediatrics, add to concerns that the medications may ultimately lead to diabetes in some kids.

Four times the risk

Using records on more than 74,000 five- to 18-year-olds from three US health plans, Dr Susan E. Andrade of the University of Massachusetts in Worcester and colleagues found that children and teens who started on an antipsychotic had four times the risk of being diagnosed with diabetes compared to kids not using any psychiatric medication.

Of those kids, 9,636 started on a second-generation antipsychotic during the study period. And out of the entire study group, 57 kids were diagnosed with diabetes.

The annual incidence of diabetes per 1,000 children was just over three cases in children treated with antipsychotics, compared to just under 0.8 cases among controls.

It's the growing use of second-generation antipsychotics in kids – particularly for conditions in which the benefit is unclear – that makes the potential diabetes risk concerning, according to Dr Jonathan Mink, chief of child neurology at the University of Rochester Medical Centre in New York.

Risks monitored

These medications can be very helpful in certain settings, said Dr Mink, who is also part of a paediatric advisory panel to the US Food and Drug Administration. In September, the panel recommended that the agency keep monitoring the risks of weight gain and diabetes in children on antipsychotics.

The drugs are often effective, for example, in managing aggressive behaviour in children with autism. In other cases – like ADHD, Dr Mink noted, effectiveness has not been established.

Exactly why antipsychotics would lead to diabetes in some children is not clear. It's known that they can spur weight gain, but Dr Mink says it's hard to argue that it's just weight gain.

In this study, kids on antipsychotics who developed diabetes was diagnosed an average of 4.5 months after starting the drug. That's a short period of time, Dr Mink noted. And it's not clear, he said, exactly how the drugs could lead to diabetes in that time frame.

Risk is real

The take-home from this study, to me, is that this risk is real, Dr Mink said. It's something we should take seriously.

Dr Andrade's team also found that while children on antipsychotics were at relatively higher risk of diabetes than those not on any psychiatric medication, their risk was not statistically greater compared with kids on antidepressants.

With antidepressants, the diabetes rate was just under two cases per 1,000 kids per year.

US researchers have found that children's use of antipsychotics increased by 65% from 2002 to 2009, primarily through prescriptions for teenagers.

From fall 2009 to spring of this year, 1.9 million prescriptions of Abilify alone were dispensed to patients under 18, including even 875 prescriptions for toddlers younger than two, according to FDA research.

(Reuters Health, November 2011) 

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