title: Risk of diabetes in children and adolescents exposed to antipsychotics: a nationwide 12-year case-control study.
abstract: OBJECTIVE
  Antipsychotics are associated with weight gain and diabetes. The risk and rate of diabetes in children and adolescents treated with antipsychotics is unclear.
  
  
  METHODS
  A longitudinal register linkage case-control study of diabetes in all psychiatric patients aged <18 years in Denmark was performed from January 1999 through the end of June 2010. Patients with and without antipsychotic exposure were compared regarding the occurrence of type 2 diabetes, defined as the prescription of oral antidiabetic medication. Regression analyses with type 2 diabetes as the dependent variable were conducted with sex, age, and diagnoses as covariates.
  
  
  RESULTS
  We compared the risk of diabetes in 48,299 psychiatrically ill youth. Of 7,253 youth exposed to antipsychotics, 52 (0.72%; 95% CI = 0.52% - 0.91%) developed type 2 diabetes. Of 41,046 youth without exposure to antipsychotics, 111 (0.27%; 95% CI = 0.22% - 0.32%) developed type 2 diabetes. In a 25,033 + 16,013 logistic regression analysis, type 2 diabetes development was associated with antipsychotic drug exposure (odds ratio [OR] = 1.60; 95% CI = 1.08 - 2.36, p < .05) female sex, (OR = 4.48; 95% CI = 2.90 - 6.91, p < 0.001) and older age at first psychiatric diagnosis (OR = 1.19; 95% CI = 1.12 - 1.27, p < 0.001), but not with psychiatric diagnosis. In a Cox-regression analysis, shorter time to type 2 diabetes onset was associated with female sex (Hazard Ratio (HR) = 4.83; 95% CI = 3.05-7.66, p = 0.001), and older age at first psychiatric diagnosis (HR = 1.19; 95% CI = 1.12-1.28, p = 0.001), while antipsychotic exposure (HR) = 1.41; 95% CI = 0.92-2.16, p = 0.11) trended towards increasing the rate of diabetes.
  
  
  CONCLUSIONS
  Antipsychotic treatment, female sex, and older age at psychiatric diagnosis were associated with a significantly more frequent type 2 diabetes onset in children and adolescents. Strict indications for antipsychotic treatment and routine cardiometabolic monitoring are crucial.
authors.affiliation: Aalborg University Hospital, Aalborg, Denmark. Electronic address: ren@rn.dk.
authors.forename: René Ernst
authors.initials: RE
authors.lastname: Nielsen
authors.affiliation: Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Mathilde Frahm
authors.initials: MF
authors.lastname: Laursen
authors.affiliation: Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Ditte Lammers
authors.initials: DL
authors.lastname: Vernal
authors.affiliation: Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Bisgaard
authors.affiliation: Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Jakobsen
authors.affiliation: Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Steinhausen
authors.affiliation: Zucker Hillside Hospital, North Shore Long Island Jewish Health System, Glen Oaks, NY and Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries / Q000706:statistics & numerical data*
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotics; diabetes; risk factors