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Antipsychotic Drugs and Hyperglycemia in Older Patients With Diabetes
Lorraine L. Lipscombe, MD, MSc;
Linda Lévesque, BScPharm, PhD;
Andrea Gruneir, PhD;
Hadas D. Fischer, MD;
David N. Juurlink, BPharm, MD, PhD;
Sudeep S. Gill, MD, MSc;
Nathan Herrmann, MD;
Janet E. Hux, MD, MSc;
Geoff M. Anderson, MD, PhD;
Paula A. Rochon, MD, MPH
Arch Intern Med. 2009;169(14):1282-1289.
Background Evidence suggests that there is an association between antipsychotic drugs and new-onset diabetes, but little is known about the risk of hyperglycemia among persons with preexisting diabetes.
Methods Using a nested case-control design and population-based health databases in Ontario, Canada, persons aged 66 years or older with diabetes who started treatment with an antipsychotic drug from April 1, 2002, to March 31, 2006, were followed up from treatment start until March 31, 2007. The cohort was subdivided into 3 groups: insulin-treated, oral hypoglycemic agent only–treated, and no diabetes treatment. We defined cases as patients hospitalized (emergency department visit or hospital admissions) for hyperglycemia. Each case was matched with up to 10 controls. We compared the likelihood of hyperglycemia among current users of atypical and typical antipsychotic agents with that among remote antipsychotic users (discontinued >180 days), based on prescriptions closest to event date.
Results Of 13 817 patients studied, 1515 (11.0%) were hospitalized for hyperglycemia. Current antipsychotic treatment was associated with a higher risk of hyperglycemia compared with remote antipsychotic use in all diabetes treatment groups (overall adjusted rate ratio, 1.50; 95% confidence interval, 1.29-1.74). The risk was increased among patients who were treated with atypical and typical antipsychotic agents and was extremely high among patients who were just starting treatment (only 1 prescription before event).
Conclusions Among older patients with diabetes, the initiation of treatment with antipsychotic drugs was associated with a significantly increased risk of hospitalization for hyperglycemia (P < .001). The risk was particularly high during the initial course of treatment and was increased with the use of all antipsychotic agents.
Author Affiliations: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (Drs Lipscombe, Lévesque, Fischer, Juurlink, Gill, Hux, Anderson, and Rochon); Departments of Medicine (Drs Lipscombe, Juurlink, Hux, and Rochon) and Health Policy, Management, and Evaluation (Drs Juurlink, Hux, Anderson and Rochon), University of Toronto; Departments of Community Health and Epidemiology (Dr Lévesque) and Medicine (Dr Gill), Queen's University, Kingston, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto (Drs Lipscombe, Gruneir, and Rochon); and Sunnybrook Health Sciences Centre, Toronto (Drs Juurlink, Herrmann, and Hux).
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