title: Atypical antipsychotic initiation and the risk of type II diabetes in children and adolescents.
abstract: OBJECTIVE
  To estimate the risk of type II diabetes (T2DM) in children and adolescents initiating atypical antipsychotic (AAP) therapy.
  
  
  METHODS
  We conducted a retrospective cohort study using a new user design approach. Medical and pharmacy claims data between 1 January 2007 and 31 December 2009 for dependents ages 4 to 18 from an employed, commercially insured population from across the USA were included. AAP exposure was defined in the presence of a pharmacy claim preceded by at least six months of AAP-free history. We used propensity score (PS) methodology to identify and match incident AAP users and non-users. New-onset T2DM, was defined based on medical and pharmacy claims. Follow-up was extended until the date of new-onset T2DM or the end of the study period. The risk of T2DM was evaluated in an intent to treat fashion using the Kaplan-Meier estimator and Cox proportional hazard regression that provided hazard ratio (HR) and associated 95% confidence interval (CI).
  
  
  RESULTS
  Our study population included 6236 new AAP users and 22 080 non-users. In this PS-matched sample, the estimated risk of T2DM was twice as high in AAP users as non-users (HR 2.18, 95% CI 1.45-3.29). Noticeable risk differences between AAP-treated and control groups materialized within four months of AAP initiation and became constant after six months until the end of the follow-up.
  
  
  CONCLUSIONS
  Children and adolescents who were prescribed an AAP medication had a two times higher risk of developing T2DM; our study raises questions about continued AAP use in children and adolescents.
authors: College of Pharmacy, Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA.|Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, USA.|Department of Pharmaceutical Sciences, College of Pharmacy, Ferris State University, Big Rapids, MI, USA.
authors: Minji
authors: M
authors: Sohn
authors: College of Pharmacy, Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA.|Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, USA.
authors: Jeffery
authors: J
authors: Talbert
authors: College of Pharmacy, Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA.|Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, USA.
authors: Karen
authors: K
authors: Blumenschein
authors: College of Pharmacy, Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA.|Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, USA.|Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA.
authors: Daniela Claudia
authors: DC
authors: Moga
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents
keywords: atypical antipsychotics; children; pharmacoepidemiology; risk; type II diabetes