抗精神病药与儿童和青少年 2 型糖尿病风险。
Antipsychotics and the risk of type 2 diabetes mellitus in children and youth.
机构信息
Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee.
出版信息
JAMA Psychiatry. 2013 Oct;70(10):1067-75. doi: 10.1001/jamapsychiatry.2013.2053.
IMPORTANCE
The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus.
OBJECTIVE
To compare the risk of type 2 diabetes in children and youth 6 to 24 years of age for recent initiators of antipsychotic drugs vs propensity score-matched controls who had recently initiated another psychotropic medication.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of the Tennessee Medicaid program with 28 858 recent initiators of antipsychotic drugs and 14 429 matched controls. The cohort excluded patients who previously received a diagnosis of diabetes, schizophrenia, or some other condition for which antipsychotics are the only generally recognized therapy.
MAIN OUTCOMES AND MEASURES
Newly diagnosed diabetes during follow-up, as identified from diagnoses and diabetes medication prescriptions.
RESULTS
Users of antipsychotics had a 3-fold increased risk for type 2 diabetes (HR = 3.03 [95% CI = 1.73-5.32]), which was apparent within the first year of follow-up (HR = 2.49 [95% CI = 1.27-4.88]). The risk increased with cumulative dose during follow-up, with HRs of 2.13 (95% CI = 1.06-4.27), 3.42 (95% CI = 1.88-6.24), and 5.43 (95% CI = 2.34-12.61) for respective cumulative doses (gram equivalents of chlorpromazine) of more than 5 g, 5 to 99 g, and 100 g or more (P < .04). The risk remained elevated for up to 1 year following discontinuation of antipsychotic use (HR = 2.57 [95% CI = 1.34-4.91]). When the cohort was restricted to children 6 to 17 years of age, antipsychotic users had more than a 3-fold increased risk of type 2 diabetes (HR = 3.14 [95% CI = 1.50-6.56]), and the risk increased significantly with increasing cumulative dose (P < .03). The risk was increased for use restricted to atypical antipsychotics (HR = 2.89 [95% CI = 1.64-5.10]) or to risperidone (HR = 2.20 [95% CI = 1.14-4.26]).
CONCLUSIONS AND RELEVANCE
Children and youth prescribed antipsychotics had an increased risk of type 2 diabetes that increased with cumulative dose.
重要性
抗精神病药物在儿童和青少年中的处方量增加，这使得人们越发担忧这种做法会增加 2 型糖尿病的风险。
目的
比较最近开始使用抗精神病药物和最近开始使用另一种精神药物的患者的 6 至 24 岁儿童和青少年 2 型糖尿病的风险。
设计、设置和参与者：回顾性队列研究，对象为田纳西州医疗补助计划中的 28858 名最近开始使用抗精神病药物的患者和 14429 名匹配的对照者。该队列排除了之前被诊断为糖尿病、精神分裂症或其他仅用抗精神病药物治疗的疾病的患者。
主要结果和措施
随访期间新诊断出的糖尿病，通过诊断和糖尿病药物处方确定。
结果
使用抗精神病药物的患者患 2 型糖尿病的风险增加了 3 倍（HR=3.03[95%CI=1.73-5.32]），这种风险在随访的第一年就显现出来（HR=2.49[95%CI=1.27-4.88]）。在随访期间，随着累积剂量的增加，风险也增加，累积剂量分别为 5 克以上（氯丙嗪克当量）、5 至 99 克和 100 克或更多时，风险比分别为 2.13（95%CI=1.06-4.27）、3.42（95%CI=1.88-6.24）和 5.43（95%CI=2.34-12.61）（P＜0.04）。抗精神病药物停药后长达 1 年，风险仍然升高（HR=2.57[95%CI=1.34-4.91]）。当将队列限制在 6 至 17 岁的儿童时，使用抗精神病药物的患者患 2 型糖尿病的风险增加了 3 倍以上（HR=3.14[95%CI=1.50-6.56]），并且随着累积剂量的增加，风险显著增加（P＜0.03）。风险增加与使用非典型抗精神病药物（HR=2.89[95%CI=1.64-5.10]）或利培酮（HR=2.20[95%CI=1.14-4.26]）有关。
结论和相关性
处方抗精神病药物的儿童和青少年患 2 型糖尿病的风险增加，且这种风险随累积剂量的增加而增加。
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