Initiation of antipsychotic medications is linked to a measurable increase in pharmacologically treated type 2 diabetes among young people, according to a Dutch cohort study published in JAMA Network Open. Led by Ravish Nilish Gangapersad, MSc, of Erasmus University Medical Center in Rotterdam, the research evaluated nearly 90,000 youths and found that the risk persists even among patients who used the medications for only one year.
Antipsychotic Initiation and Rising Type 2 Diabetes Risk in Youths
The Dutch cohort study analyzed data from Statistics Netherlands to track the prevalence of pharmacologically treated type 2 diabetes up to five years before and after the start of antipsychotic treatments. The evaluation included 89,991 patients between the ages of 0 and 19 who received at least one antipsychotic prescription between 2006 and 2022. The median age at the start of treatment was 13.6 years, and 62% of the participants were male.
According to the findings, the annual risk difference for pharmacologically treated type 2 diabetes increased from 2.47 per 10,000 users in the initiation year to 9.02 per 10,000 users by year 5. The corresponding change in relative risk moved from 0.89 in year 0 to 1.84 in year 1, reaching 3.25 by year 5. Recurrent users faced even higher risks, showing a risk difference of 10.17 per 10,000 users by year 5. However, researchers noted that an elevated risk persisted even among patients who took antipsychotics solely during the first year they were dispensed, showing a risk difference of 4.36.
Did you know? While antipsychotics are frequently prescribed for young patients, studies indicate that females experience a greater absolute excess risk of type 2 diabetes by year 5 compared to males, with a risk difference of 16.48 versus 5.50 per 10,000 users.
Off-Label Prescribing and Clinical Implications
Antipsychotics are primarily used off-label for young patients to manage conditions such as attention deficit-hyperactivity disorder, anxiety, sleep disturbances, and autism spectrum disorder-related irritability. Nina Kraguljac, MD, a psychiatrist at the Ohio State University Wexner Medical Center in Columbus who was not involved in the study, told MedPage Today that the persistence of diabetes risk even after stopping the medication is a critical clinical factor.
Kraguljac noted that while antipsychotics remain clinically necessary for conditions with few alternative treatments, such as schizophrenia or autism spectrum disorder, she would be much more hesitant to prescribe them for anxiety or insomnia, particularly if a young patient already carries other risk factors for diabetes. She also emphasized that comparing diabetes risk within the same person before and after starting treatment builds strong confidence that the risk is medication-induced rather than driven by external factors.
| Demographic Group | Year-5 Risk Difference (per 10,000 users) |
|---|---|
| Females | 16.48 |
| Males | 5.50 |
| Adolescents (Ages 13–19) | 14.09 |
| Children (Ages 7–12) | 5.47 |
Demographic Differences in Metabolic Risk
The study identified notable variations in risk based on age and sex. Adolescents between the ages of 13 and 19 experienced a larger long-term increase in risk compared to children ages 7 to 12, with year-5 risk differences of 14.09 and 5.47 per 10,000 users, respectively. Gangapersad and co-authors stated that the higher cumulative risk observed among females aligns with previous findings regarding elevated rates of antipsychotic-induced weight gain and metabolic complications in female patients.
The authors acknowledged that the study tracked only pharmacologically treated type 2 diabetes. Consequently, the findings likely underestimate the total occurrence by excluding lifestyle-managed or undiagnosed cases. Gangapersad’s team concluded that the findings highlight the necessity for cautious prescribing habits, structured metabolic monitoring, and early preventive strategies to mitigate long-term health and economic consequences.
Pro Tip: Clinicians evaluating young patients for antipsychotic therapy should weigh metabolic risk factors carefully, particularly when treating off-label conditions where alternative interventions may be viable.
Frequently Asked Questions
What conditions are antipsychotics commonly prescribed for in youths?
Antipsychotics are frequently used off-label for young people to treat attention deficit-hyperactivity disorder, anxiety, sleep disturbances, and irritability related to autism spectrum disorder.
Does the risk of type 2 diabetes disappear after stopping antipsychotics?
According to psychiatric experts discussing the research, the increased risk for diabetes remains elevated even after an antipsychotic medication is stopped.
Which demographic groups showed the highest risk in the Dutch cohort study?
Females and adolescents aged 13 to 19 showed greater absolute excess risks and larger long-term increases in type 2 diabetes prevalence by year 5 compared to males and younger children.
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