Liu Shengxin, Lagerberg Tyra, Ludvigsson Jonas F, Taylor Mark J, Chang Zheng, D'Onofrio Brian M, Larsson Henrik, Lichtenstein Paul, Gudbjörnsdottir Soffia, Kuja-Halkola Ralf, Butwicka Agnieszka
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.
JAMA Netw Open. 2023 Oct 2;6(10):e2336621. doi: 10.1001/jamanetworkopen.2023.36621.
Children and adolescents with type 1 diabetes (T1D) face elevated risks of psychiatric disorders. Despite their nonnegligible adverse effects, psychotropic medications are a common cost-effective approach to alleviating psychiatric symptoms, but evidence regarding their dispensation to children and adolescents with T1D remains lacking.
To examine the trends and patterns of psychotropic medication dispensation among children and adolescents with T1D in Sweden between 2006 and 2019.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from multiple Swedish registers. The main study cohort included children and adolescents residing in Sweden from 2006 to 2019 and was followed up until the earliest of December 31, 2019, 18th birthday, emigration, or death. Data analyses were conducted from November 1, 2022, to April 30, 2023.
Type 1 diabetes.
The primary outcomes were trends and patterns of psychotropic medication dispensation (including antipsychotics, antidepressants, anxiolytics, hypnotics, mood stabilizers, and medications for attention-deficit/hyperactivity disorder [ADHD]), psychotropic medication initiation, and history of neurodevelopmental and psychiatric diagnosis. Cumulative incidence curves and Cox proportional hazard models were used to estimate the aggregated incidence and hazard ratios of medication initiation after diabetes onset.
Of 3 723 745 children and adolescents (1 896 199 boys [50.9%]), 13 200 (0.4%; 7242 boys [54.9%]) had T1D (median [IQR] age at diagnosis, 11.1 [7.6-14.7] years). Between 2006 and 2019, psychotropic medication dispensation increased from 0.85% (95% CI, 0.65%-1.10%) to 3.84% (3.11%-4.69%) among children and from 2.72% (95% CI, 2.15%-3.39%) to 13.54% (95% CI, 12.88%-14.23%) among adolescents with T1D, consistently higher than their peers without T1D. The most commonly dispensed medications included hypnotics, ADHD medications, anxiolytics, and selective serotonin reuptake inhibitors, and all exhibited increasing trends. For those with T1D, psychiatric care was the primary prescription source, and up to 50.1% of treatments lasted more than 12 months. In addition, children and adolescents with T1D showed higher cumulative incidence and hazard ratios of medication initiation after diabetes onset than their same-age and same-sex counterparts.
This cohort study found an increasing trend in psychotropic medication dispensation among children and adolescents with T1D from 2006 to 2019, persistently higher than those without T1D. These findings call for further in-depth investigations into the benefits and risks of psychotropic medications within this population and highlight the importance of integrating pediatric diabetes care and mental health care for early detection of psychological needs and careful monitoring of medication use.
1型糖尿病（T1D）患儿和青少年面临着更高的精神障碍风险。尽管精神药物有不可忽视的副作用，但它们是缓解精神症状的一种常见且具有成本效益的方法，然而，关于向T1D患儿和青少年配药的证据仍然不足。
研究2006年至2019年瑞典T1D患儿和青少年精神药物配药的趋势和模式。
设计、背景和参与者：这项队列研究使用了瑞典多个登记处的数据。主要研究队列包括2006年至2019年居住在瑞典的儿童和青少年，随访至2019年12月31日、18岁生日、移民或死亡最早发生的时间。数据分析于2022年11月1日至2023年4月30日进行。
1型糖尿病。
主要结局是精神药物配药的趋势和模式（包括抗精神病药、抗抑郁药、抗焦虑药、催眠药、心境稳定剂和注意力缺陷/多动障碍[ADHD]药物）、精神药物起始使用情况以及神经发育和精神诊断史。使用累积发病率曲线和Cox比例风险模型来估计糖尿病发病后药物起始使用的总体发病率和风险比。
在3723745名儿童和青少年（1896199名男孩[50.9%]）中，13200名（0.4%；7242名男孩[54.9%]）患有T1D（诊断时的中位[四分位间距]年龄为11.1[7.6 - 14.7]岁）。2006年至2019年期间，T1D患儿的精神药物配药率从0.85%（95%CI，0.65% - 1.10%）增至3.84%（3.11% - 4.69%），T1D青少年从2.72%（95%CI，2.15% - 3.39%）增至13.54%（95%CI，12.88% - 14.23%），始终高于无T1D的同龄人。最常配的药物包括催眠药、ADHD药物、抗焦虑药和选择性5-羟色胺再摄取抑制剂，且均呈上升趋势。对于T1D患者，精神科护理是主要的处方来源，高达50.1%的治疗持续超过12个月。此外，T1D患儿和青少年在糖尿病发病后药物起始使用的累积发病率和风险比高于同龄及同性别的对照人群。
这项队列研究发现，2006年至2019年期间，T1D患儿和青少年精神药物配药呈上升趋势，且始终高于无T1D者。这些发现呼吁对该人群中精神药物的益处和风险进行进一步深入研究，并强调整合儿科糖尿病护理和心理健康护理对于早期发现心理需求以及仔细监测药物使用的重要性。
