This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Neurology  • Dementias  • Nutritional and Metabolic Disorders  • Nutritional and Metabolic Disorders, Other  • Psychiatry  • Psychopharmacology  • Drug Therapy  • Adverse Effects  • Endocrine Diseases  • Diabetes Mellitus  • Alert me on articles by topic  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

In This Issue of Archives of Internal Medicine
Arch Intern Med. 2009;169(14):1259.
FULL TEXT