By Tom Wilemon | The Tennessean
A type of drug commonly prescribed to young people with behavioral problems is putting them at increased risk for diabetes, according to a study by Vanderbilt University researchers published online Wednesday in JAMA Psychiatry.
Those who took antipsychotics -- whose brand names include Abilify, Seroquel, Risperdal and Zyprexa -- had a threefold increased risk for developing type 2 diabetes compared to those who took other medications available for the same disorders. That's the conclusion researchers made after tracking people between the ages of 6 and 24 enrolled in Tennessee's Medicaid program over a 12-year period.
The increased risk occurred within the first year children started taking the drugs and persisted even a year after they stopped, researchers found.
Dr. Wayne A. Ray, a Vanderbilt professor of preventive medicine and co-author of the article, advised parents to ask pediatricians to try other drugs for behavioral disorders first.
"My advice would to be very cautious about starting an antipsychotic," he said. "If the child has one of these indications for one of these other medications, that means looking very carefully at alternative medication -- perhaps trying them first. ... Then, perhaps at the end of the day it may be necessary to use an antipsychotic, but you at least will have tried the safer options."
Prior studies had indicated an increased risk for diabetes among adults who took these antipsychotic medications, but studies among younger people had not been as extensive.
Weight gains of 20 to 30 pounds commonly occur when people take the drugs, Ray said.
"Weight gain certainly does increase the risk of type 2 diabetes," Ray said. "Antipsychotic users certainly gain weight, including children. Antipsychotics also affect metabolism in a way that may increase the risk for type 2 diabetes. For instance, they affect insulin resistance, which is another factor in type 2 diabetes."
Type 2 diabetes, once called adult-onset diabetes, is occurring with greater frequency among children and young people in Tennessee. Weight gain can trigger diabetes in people with a genetic predisposition to the disease, which can cause serious health complications ranging from blindness to kidney failure.
The study compared 28,858 children and youth prescribed these antipsychotics against 14,429 others who took different drugs. The 14,429 selected for this control group closely matched their profile, Ray said.
"We found the risk was increased in the first year of use," he said. "That's important because some might believe that a chronic disease like diabetes would only develop with long-term use."
Antipsychotics were once considered heavy tranquilizers and predominantly used to treat schizophrenia and other major psychosis disorders, but in the 1990s doctors began to prescribe them for attention deficit/hyperactivity disorder as well as aggressive behavior problems. These types of disorders now account for the majority of prescriptions.
"There was a new class of antipsychotic drugs introduced," Ray said. "They are called the atypical antipsychotics. Their side effects are not quite as severe as the older drugs. There was a perceived improvement in safety."
The study data was compiled from computerized Medicaid records linked with hospital discharge information matched up with birth certificates. The study period was from Jan. 1, 1996, to Dec. 31, 2007. Nearly half of Tennesseans under the age of 18 are on TennCare, the state's Medicaid program.
Researchers from the Mayo Clinic, Columbia University and the U.S. Food and Drug Administration assisted four Vanderbilt professors on the project.