title: The incidence of diabetes in atypical antipsychotic users differs according to agent--results from a multisite epidemiologic study.
abstract: OBJECTIVE
  The purpose of this study was to examine the association between atypical antipsychotics, including the newer agents, aripiprazole and ziprasidone, and newly treated diabetes, using the largest post-marketing cohort of patients exposed to these newer treatments that has been studied to date.
  
  
  METHODS
  Identified two overlapping cohorts-a simple cohort (all antipsychotic users) and an inception cohort (new users of antipsychotics)-using automated data from three United States sites (60.4 million covered lives). Patients exposed to antipsychotics > or = 45 days were identified and followed for incident diagnoses of treated diabetes. Data analysis accounted for drug switching and non-consistent drug use.
  
  
  RESULTS
  In the 55 287-member inception cohort, 357 cases of newly treated diabetes were identified. Compared with current use of typical antipsychotics, current users of aripiprazole (adjusted hazard ratio (aHR) 0.93, 95% confidence interval (CI) 0.50-1.76), quetiapine (aHR 1.04, 95%CI, 0.67-1.62), risperidone (aHR 0.85, 95%CI, 0.54-1.36) and ziprasidone (aHR 1.05, 95%CI, 0.54-2.08) had similar low risk of diabetes. Patients exposed to olanzapine had an increased risk of diabetes (aHR 1.71, 95%CI, 1.12-2.61), and although the effect estimate is imprecise, clozapine-exposed patients had a trend towards an elevated hazard ratio (aHR 2.58, 95%CI, 0.76-8.80). Results for the simple cohort were similar.
  
  
  CONCLUSIONS
  Relative to typical antipsychotics, aripiprazole, ziprasidone, risperidone and quetiapine were not associated with an increased risk of diabetes; olanzapine and clozapine were associated with an increased risk. This analysis constitutes the largest post-marketing pharmacoepidemiologic study to date that includes the newer agents.
authors.affiliation: EpiSource, Hamden, CT, USA. muyood@muyood.com
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.forename: Gerald
authors.initials: G
authors.lastname: DeLorenze
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Susan A
authors.initials: SA
authors.lastname: Oliveria
authors.forename: Ai-Lin
authors.initials: AL
authors.lastname: Tsai
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Willey
authors.forename: Robert
authors.initials: R
authors.lastname: McQuade
authors.forename: John
authors.initials: J
authors.lastname: Newcomer
authors.forename: Gilbert
authors.initials: G
authors.lastname: L'Italien
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D000077152:Olanzapine; D010879:Piperazines / Q000627:therapeutic use; D015363:Quinolones / Q000627:therapeutic use; D012189:Retrospective Studies; D013844:Thiazoles / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; C092292:ziprasidone; D000068180:Aripiprazole; D003024:Clozapine; D000077152:Olanzapine