Atypical antipsychotics and hyperglycemic emergencies: Multicentre, retrospective cohort study of administrative data

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Abstract

Objective

To evaluate the relationship between initiation of atypical antipsychotic agents and the risk of hyperglycemic emergencies.

Method

We conducted a multicentre retrospective cohort study using administrative health data from 7 Canadian provinces and the UK Clinical Practice Research Datalink. Hospitalizations for hyperglycemic emergencies (hyperglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state) were compared between new users of risperidone (reference), and new users of olanzapine, other atypical antipsychotics, and typical antipsychotics. We used propensity scores with inverse probability of treatment weighting and proportional hazard models to estimate the site-specific hazard ratios of hyperglycemic emergencies in the year following drug initiation separately for adults under and over age 66 years. Site-level results were pooled using meta-analytic methods.

Results

Among 725,489 patients, 55% were aged 66 + years; 5% of younger and 19% of older patients had pre-existing diabetes. Hyperglycemic emergencies were rare (1–2 per 1000 person years), but more frequent in patients with pre-existing diabetes (6–12 per 1000 person years). We did not find a significant difference in risk of hyperglycemic emergencies with initiation of olanzapine versus risperidone; however heterogeneity existed between sites. The risk of an event was significantly lower with other atypical (99% quetiapine) compared to risperidone use in older patients [adjusted hazard ratio, 95% confidence interval (CI): 0.69, 0.53–0.90].

Conclusions

Risk for hyperglycemic emergencies is low after initiation of antipsychotics, but patients with pre-existing diabetes may be at greater risk. The risk appeared lower with the use of quetiapine in older patients, but the clinical significance of the findings requires further study.

Keywords

Antipsychotics
Drug side effects
Psychosis
Hyperglycemic emergencies
Diabetes
Epidemiology
Database research

Cited by (0)

Previous Presentation: This work was presented on 26 August 2012, at the 28th International Conference on Pharmacoepidemiology and Therapeutic Risk Management (ICPE) in Barcelona Spain.

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The Canadian Network for Observational Drug Effect Studies (CNODES) investigators are: Samy Suissa (Principal Investigator); Colin Dormuth (British Columbia); Brenda Hemmelgarn (Alberta); Gary Teare (Saskatchewan); Patricia Martens and Patricia Caetano (Manitoba); David Henry and J. Michael Paterson (Ontario); Jacques LeLorier (Quebec); Adrian Levy (Nova Scotia); Pierre Ernst (United Kingdom Clinical Practice Research Datalink); Robert Platt (Methods); and Ingrid Sketris (Knowledge Translation). CNODES is a collaborating centre of the Drug Safety and Effectiveness Network (DSEN), funded by the Canadian Institutes of Health Research (Grant Number DSE-111845).