title: New-onset treatment-dependent diabetes mellitus and hyperlipidemia associated with atypical antipsychotic use in older adults without schizophrenia or bipolar disorder.
abstract: OBJECTIVE
  To examine the association between atypical antipsychotic medications and incident treatment for diabetes mellitus or hyperlipidemia in elderly adults without diagnoses of schizophrenia or bipolar disorder.
  
  
  METHODS
  Two case-control studies using medical and pharmacy claims data.
  
  
  METHODS
  United States managed care population from multiple insurance plans.
  
  
  METHODS
  Individuals aged 65 and older enrolled in a Medicare Advantage or commercial (health maintenance organization) managed care health plan in the western United States with no claims indicating diagnosis of schizophrenia or bipolar disorder in the 1 year pre-index period. Cases were defined as persons newly initiated on an antidiabetic (n = 13,075) or antihyperlipidemic (n = 63,829) medication on the index date. For the new diabetes mellitus analysis, 65,375 controls were matched to cases based on age, sex, health-plan type, and index date year. In the new hyperlipidemia analysis, 63,829 controls were matched to cases based on the same variables.
  
  
  METHODS
  Conditional logistic regressions were performed to determine the odds of initiated antidiabetic or antihyperlipidemic medication for participants exposed to atypical antipsychotics compared with those with no exposure. The models included comorbidities possibly associated with the outcome.
  
  
  RESULTS
  Exposure to atypical antipsychotics was associated with significantly greater adjusted odds of starting an antidiabetic medication (1.32, 95% confidence interval (CI) = 1.10-1.59) but significantly lower odds of starting an antihyperlipidemic medication (0.76, 95% CI = 0.67-0.87).
  
  
  CONCLUSIONS
  Use of atypical antipsychotics in older adults for conditions other than schizophrenia and bipolar disorder was associated with incident treatment of diabetes mellitus but not of hyperlipidemia, suggesting that older adults may be susceptible to the adverse metabolic consequences of these agents.
authors.affiliation: OptumRx, Irvine, California 92614, USA. sara.c.erickson@optum.com
authors.forename: Sara C
authors.initials: SC
authors.lastname: Erickson
authors.forename: Lisa
authors.initials: L
authors.lastname: Le
authors.forename: Armen
authors.initials: A
authors.lastname: Zakharyan
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stockl
authors.forename: Ann S M
authors.initials: AS
authors.lastname: Harada
authors.forename: Soo
authors.initials: S
authors.lastname: Borson
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: Bradford
authors.initials: B
authors.lastname: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents