Assessing the risk of type 2 diabetes mellitus among children and adolescents with psychiatric disorders treated with atypical antipsychotics: a population-based nested case–control study

Hankil Lee, Dong Ho Song, Jin Won Kwon, Euna Han, Min Jung Chang, Hye-Young Kang

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Abstract

To examine the associations between atypical antipsychotic (AAP) exposure and the development of type 2 diabetes mellitus (T2DM) in Korean pediatric patients with psychiatric disorders, we conducted a nested case–control study using the claims data of the National Health Insurance system of Korea between 2010 and 2014. A cohort of patients with psychiatric disorders was identified, and enrollment was taken as the date of the first psychiatric diagnosis. Cases involved patients with a diagnosis of T2DM or prescriptions for glucose lowering drugs after enrollment, and the identification of T2DM was defined as the index date. We performed a conditional logistic regression analysis for matched case–control data to assess associations between AAP exposure and T2DM, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) are presented. From 1,092,019 patients aged 2–19 years, we identified 20,263 cases with T2DM and 80,043 controls, matched by sex, age, enrollment date, and primary psychiatric diagnosis. After adjusting for comorbidities, psychotropic medication history, and the healthcare institution characteristics, the aOR of having T2DM was significantly higher in multi-AAP users compared with non-users (aOR 1.89; 95% CI 1.63–2.20). Particularly high ORs for T2DM were observed in clozapine users compared with non-users (aOR 3.47; 95% CI 1.88–6.41). We observed a linear relationship between the increase in risperidone dose and the increase in the risk of developing T2DM. Our findings suggest a significantly increased risk of developing T2DM in child or adolescent patients with psychiatric disorders exposed to AAPs compared with those not exposed to AAPs.

Original languageEnglish
Pages (from-to)1321-1334
Number of pages14
JournalEuropean Child and Adolescent Psychiatry
Volume27
Issue number10
DOIs
Publication statusPublished - 2018 Oct 1

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Adolescent Psychiatry
Type 2 Diabetes Mellitus
Antipsychotic Agents
Population
Psychiatry
Confidence Intervals
Mental Disorders
Risperidone
Clozapine
National Health Programs
Korea
Prescriptions
Comorbidity
Logistic Models
Odds Ratio
Regression Analysis
Pediatrics
Delivery of Health Care
Glucose

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

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title = "Assessing the risk of type 2 diabetes mellitus among children and adolescents with psychiatric disorders treated with atypical antipsychotics: a population-based nested case–control study",
abstract = "To examine the associations between atypical antipsychotic (AAP) exposure and the development of type 2 diabetes mellitus (T2DM) in Korean pediatric patients with psychiatric disorders, we conducted a nested case–control study using the claims data of the National Health Insurance system of Korea between 2010 and 2014. A cohort of patients with psychiatric disorders was identified, and enrollment was taken as the date of the first psychiatric diagnosis. Cases involved patients with a diagnosis of T2DM or prescriptions for glucose lowering drugs after enrollment, and the identification of T2DM was defined as the index date. We performed a conditional logistic regression analysis for matched case–control data to assess associations between AAP exposure and T2DM, and adjusted odds ratios (aORs) with 95{\%} confidence intervals (CIs) are presented. From 1,092,019 patients aged 2–19 years, we identified 20,263 cases with T2DM and 80,043 controls, matched by sex, age, enrollment date, and primary psychiatric diagnosis. After adjusting for comorbidities, psychotropic medication history, and the healthcare institution characteristics, the aOR of having T2DM was significantly higher in multi-AAP users compared with non-users (aOR 1.89; 95{\%} CI 1.63–2.20). Particularly high ORs for T2DM were observed in clozapine users compared with non-users (aOR 3.47; 95{\%} CI 1.88–6.41). We observed a linear relationship between the increase in risperidone dose and the increase in the risk of developing T2DM. Our findings suggest a significantly increased risk of developing T2DM in child or adolescent patients with psychiatric disorders exposed to AAPs compared with those not exposed to AAPs.",
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Assessing the risk of type 2 diabetes mellitus among children and adolescents with psychiatric disorders treated with atypical antipsychotics : a population-based nested case–control study. / Lee, Hankil; Song, Dong Ho; Kwon, Jin Won; Han, Euna; Chang, Min Jung; Kang, Hye-Young.

In: European Child and Adolescent Psychiatry, Vol. 27, No. 10, 01.10.2018, p. 1321-1334.

Research output: Contribution to journalArticle

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