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Antipsychotics Associated With Hyperglycemia in Older Adults With Diabetes CHICAGO -- July 28, 2009 -- Older patients with diabetes who take antipsychotic medications appear to have an increased risk of hospitalisation for hyperglycemia, especially soon after beginning treatment, according to a study published in the July 27 issue of Archives of Internal Medicine. "The risk of diabetes may be partly related to chronic effects of the weight gain associated with antipsychotic agents," the authors wrote. "However, case reports of acute hyperglycemia after the initiation of therapy with these drugs suggest that they may also be associated with acute glycemic changes." Lorraine L. Lipscombe, MD, Institute for Clinical Evaluative Sciences, University of Toronto and Women's College Research Institute at Women's College Hospital, Toronto, Ontario, and colleagues studied 13,817 individuals aged 66 years and older (mean age, 78 years) with diabetes who began treatment with antipsychotics between April 1, 2002, and March 31, 2006. Each patient who was hospitalised for hyperglycemia during the observation period -- through March 31, 2007, an average of 2 years of follow-up -- was considered a case and was matched with up to 10 control patients who were the same age and sex but were not hospitalised over the same time period. The researchers then compared the likelihood of hyperglycemia among those who were currently taking antipsychotic medications to those who had discontinued antipsychotic medications for more than 180 days. Of the total group of 13,817 patients, 1,515 (11%) were hospitalised for hyperglycemia. Those who were currently taking antipsychotic drugs had a higher risk of hospitalisation than those who had stopped the medications more than 180 days ago. The risk was highest among those who were just starting antipsychotic drug treatment. "Our study indicates that the initiation of antipsychotic therapy represents a critical period during which seniors with diabetes are particularly vulnerable to metabolic decompensation," the authors wrote. "The new use of both atypical and typical antipsychotic drugs was associated with a significant increase in hospitalisations for hyperglycemia, which appeared independent of baseline diabetes treatment and was strikingly high during the initial period of antipsychotic therapy." "In the meantime, other options to manage behavioural symptoms of dementia should be considered among older persons with diabetes," they concluded. "Patients and their families should be alerted to observe for signs of glycemic decompensation when treatment with an antipsychotic agent is initiated, and enhanced glucose monitoring is recommended for all patients for whom an antipsychotic drug is prescribed, particularly after treatment initiation." SOURCE: Archives of Internal Medicine E-mail this page to a friend or colleague! To print, use this version