title: Do antipsychotics increase diabetes risk in children and adolescents?
abstract: BACKGROUND
  Glucose dysregulation and type 2 diabetes mellitus (T2DM) are feared antipsychotic drug adverse effects. Despite increasing utilization, data about antipsychotic risk of T2DM in youth are scarce.
  
  
  METHODS
  We conducted a systematic PubMed/MEDLINE search until 15 May 2014 focusing on studies with ≥ 20 youths aged ≤ 24 years, reporting quantitative data on: i) change in fasting glucose, hemoglobin A1c, insulin or insulin resistance after antipsychotic initiation (studies = 19, n = 2123,age = 13.3 years, follow up = 28.8 weeks); or ii) prevalence (studies = 4) or incidence (studies = 8, follow up = 1.57 years) of T2DM in antipsychotic-exposed youth (studies = 10, n = 65,486, age = 14.2 years) versus healthy controls (studies = 4, n = 246,828), psychiatric controls (studies = 5, n = 61,784) or without control groups (studies = 2).
  
  
  CONCLUSIONS
  Antipsychotics are associated with early adverse changes in glucose metabolism that are greater with all analyzable antipsychotics compared to controls, being highest with olanzapine, followed by quetiapine, aripiprazole and risperidone; but data were scarce. Although T2DM is fortunately rare in antipsychotic-treated youth, its prevalence (odds ratio [OR] = 8.176, 95% CI = 7.139 - 9.362) and incidence (OR = 1.450, 95% CI = 1.101 - 1.911, p = 0.006) were higher than in healthy controls. Similarly, T2DM prevalence (OR = 3.475, 95% CI = 3.019 - 4.001, p < 0.0001) and incidence (OR = 5.376, 95% CI = 4.004 - 7.233, p < 0.0001, excluding one outlying study) were higher than in psychiatric controls. Antipsychotics should only be used after lower-risk interventions failed, and inappropriately low clinical metabolic monitoring must be remedied.
authors.affiliation: Zucker Hillside Hospital, Psychiatry Research , 75-59 263rd Street, Glen Oaks, NY 11001 , USA.
authors.forename: Britta
authors.initials: B
authors.lastname: Galling
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D000367:Age Factors; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000187:drug effects; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000453:epidemiology*; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: adolescents; antipsychotics; children; diabetes; glucose; healthy controls; hemoglobin A1c; incidence; insulin; psychiatric controls