title: Antipsychotics and the risk of type 2 diabetes mellitus in children and youth.
abstract: OBJECTIVE
  The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus.
  
  
  OBJECTIVE
  To compare the risk of type 2 diabetes in children and youth 6 to 24 years of age for recent initiators of antipsychotic drugs vs propensity score-matched controls who had recently initiated another psychotropic medication.
  
  
  METHODS
  Retrospective cohort study of the Tennessee Medicaid program with 28 858 recent initiators of antipsychotic drugs and 14 429 matched controls. The cohort excluded patients who previously received a diagnosis of diabetes, schizophrenia, or some other condition for which antipsychotics are the only generally recognized therapy.
  
  
  METHODS
  Newly diagnosed diabetes during follow-up, as identified from diagnoses and diabetes medication prescriptions.
  
  
  RESULTS
  Users of antipsychotics had a 3-fold increased risk for type 2 diabetes (HR = 3.03 [95% CI = 1.73-5.32]), which was apparent within the first year of follow-up (HR = 2.49 [95% CI = 1.27-4.88]). The risk increased with cumulative dose during follow-up, with HRs of 2.13 (95% CI = 1.06-4.27), 3.42 (95% CI = 1.88-6.24), and 5.43 (95% CI = 2.34-12.61) for respective cumulative doses (gram equivalents of chlorpromazine) of more than 5 g, 5 to 99 g, and 100 g or more (P < .04). The risk remained elevated for up to 1 year following discontinuation of antipsychotic use (HR = 2.57 [95% CI = 1.34-4.91]). When the cohort was restricted to children 6 to 17 years of age, antipsychotic users had more than a 3-fold increased risk of type 2 diabetes (HR = 3.14 [95% CI = 1.50-6.56]), and the risk increased significantly with increasing cumulative dose (P < .03). The risk was increased for use restricted to atypical antipsychotics (HR = 2.89 [95% CI = 1.64-5.10]) or to risperidone (HR = 2.20 [95% CI = 1.14-4.26]).
  
  
  CONCLUSIONS
  Children and youth prescribed antipsychotics had an increased risk of type 2 diabetes that increased with cumulative dose.
authors: Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: William V
authors: WV
authors: Bobo
authors: William O
authors: WO
authors: Cooper
authors: C Michael
authors: CM
authors: Stein
authors: Mark
authors: M
authors: Olfson
authors: David
authors: D
authors: Graham
authors: James
authors: J
authors: Daugherty
authors: D Catherine
authors: DC
authors: Fuchs
authors: Wayne A
authors: WA
authors: Ray
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D011619:Psychotropic Drugs / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents; D011619:Psychotropic Drugs