title: Risk of Hospitalization for Hypoglycemia in Older Patients with Diabetes Using Antipsychotic Drugs.
abstract: OBJECTIVE
  Antipsychotics may disrupt metabolic regulation in patients with diabetes mellitus. The risk of hypoglycemia in older users of antipsychotics with diabetes is largely unknown. Therefore, we investigated the association between the use of antipsychotic drugs and hypoglycemia requiring hospital admission in older patients with diabetes.
  
  
  METHODS
  In a nested case-control study using community pharmacy records linked to hospital admission data in the Netherlands (1998-2008), a cohort of 68,314 patients at least 65 years with diabetes was studied. Cases were patients from the study cohort with a first hospital admission for hypoglycemia; up to five comparison subjects were selected for each case. Exposure to antipsychotic drugs was the primary determinant of interest. Logistic regression analysis was performed to estimate the strength of the association between antipsychotic drug use and hypoglycemia, taking into account potential confounders.
  
  
  RESULTS
  Eight hundred fifteen patients were admitted to hospital for hypoglycemia. Current use of antipsychotic drugs was associated with an increased risk of hypoglycemia compared with non-use (adjusted OR: 2.26; 95% CI: 1.45-3.52; Wald χ(2) = 13.08, df = 1, p ≤0.001), especially in the first 30 days of treatment (adjusted OR: 7.65; 95% CI: 2.50-23.41; Wald χ(2) = 12.72, df = 1, p ≤0.001) and with higher doses (adjusted OR: 8.20; 95% CI: 3.09-21.75; Wald χ(2) = 17.90, df = 1, p ≤0.001).
  
  
  CONCLUSIONS
  Use of antipsychotic drugs by older patients with diabetes mellitus was associated with an increased risk of hospitalization for hypoglycemia. Our findings suggest that glucose levels should be monitored closely after initiation of antipsychotic drugs.
authors.affiliation: Department of Clinical Pharmacy, Tergooi Hospitals Hilversum, Hilversum, the Netherlands; Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands. Electronic address: kvankeulen@tergooi.nl.
authors.forename: Kris
authors.initials: K
authors.lastname: van Keulen
authors.affiliation: Department of Clinical Pharmacy, Tergooi Hospitals Hilversum, Hilversum, the Netherlands.
authors.forename: Paul D
authors.initials: PD
authors.lastname: van der Linden
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Souverein
authors.affiliation: Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands.
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink
authors.affiliation: Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands.
authors.forename: Antoine C G
authors.initials: AC
authors.lastname: Egberts
authors.affiliation: Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Wilma
authors.initials: W
authors.lastname: Knol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents
keywords: Older patients; antipsychotic drugs; diabetes mellitus; hypoglycemia