Risk of diabetes in children, adolescents exposed to antipsychotics: Danish 12-year case-control study

Using data from the nationwide Danish registers, a group of researchers led by Dr. René Ernst Nielsen, Psychiatry, Aalborg University Hospital, Denmark, studied 48,299 children and adolescents with psychiatric disorders to document the frequency and possible predictors of type II diabetes, defined by treatment with an oral antidiabetic drug.

The study found that the absolute risk of diabetes in psychiatrically ill youth exposed to antipsychotic medications was approximately 0.72% compared to 0.27% in those not exposed to antipsychotics. Especially female sex and antipsychotic drug exposure increased the risk of developing type II diabetes, while type of psychiatric diagnosis was not related to diabetes development.

Taken together, these data raise further concern about the frequent use of antipsychotics for non-psychotic disorders and off-label conditions, such as disruptive behavior disorders, which should first be treated with non-pharmacologic management options. Moreover, regular cardiometabolic monitoring, including fasting glucose and hemoglobin A1C testing should be integral part of antipsychotic prescribing to children and adolescents.

Dr. Nielsen said of the study, "The use of antipsychotic drug treatment can be necessary for some of the psychiatric disorders diagnosed in children and adolescents. This study underscores the importance of following the current guidelines that antipsychotics should only be used in children and adolescents when other evidence-based and safer treatment options have been exhausted."

The study was a longitudinal register linkage case control study of type II diabetes, defined as prescription of an oral antidiabetic drug, in all child and adolescent hospital-based psychiatric patients diagnosed in Denmark from January 1st 1999 and June 30st 2010. The time period was defined to allow full retrieval of data from all relevant registers.