Antipsychotic treatment ups risk of diabetes in schizophrenia
People with schizophrenia tend to have a high endogenous risk for diabetes, and both first- and second-generation antipsychotics further increase such risk, according to a study.
Researchers followed all individuals born in Denmark on or after 1 January 1977 until 1 January 2013 (n=2,736,510). Schizophrenia diagnoses were ascertained by the Danish Psychiatric Central Research Register. Data on prescriptions of antipsychotics were provided by the Danish National Prescription Registry, which along with the Danish National Patient Register ascertained diabetes.
Cox proportional hazards regression models, accounting for potential confounders, were used to estimate the endogenous and antipsychotic-related risks for diabetes.
A total of 14,118 cohort members (0.52 percent) developed diabetes, and 8.945 (0.33 percent) developed schizophrenia during follow-up (49,582,279 person-years).
Compared with the general population, those with antipsychotic-naïve schizophrenia had an adjusted hazard ratio (AHR) for diabetes of 3.07 (95 percent CI, 1.71 to 5.41). After adjustment for family history of diabetes and other potential confounders, the risk for diabetes after starting antipsychotic treatment was significantly higher (AHR, 3.64; 1.95 to 6.82) than the risk in antipsychotic-naïve schizophrenia.
The risk for diabetes increased with first-line treatment with either first- (AHR, 3.06; 1.32 to 7.05) or second-generation antipsychotics (AHR, 3.44; 1.73 to 6.83) without a statistically significant difference. These results were validated by appropriate sensitivity analyses limited to type 2 diabetes.
“Early detection and effective treatment of diabetes should be an integral part of multidisciplinary management of schizophrenia regardless of antipsychotic drug exposure,” researchers said, adding that diabetes mellitus contributes to excessive cardiovascular deaths and reduced life expectancy in schizophrenia.