Risk of diabetes mellitus associated with atypical antipsychotic use among patients with bipolar disorder: A retrospective, population-based, case-control study
Risk of diabetes mellitus associated with atypical antipsychotic use among patients with bipolar disorder: A retrospective, population-based, case-control study
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DOI：
10.4088/jcp.v67n0707
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发表时间：
2006-07-01
影响因子：
5.3
通讯作者：
L'Italien, Gilbert J.
中科院分区：
文献类型：
--
作者：
Guo, Jeff J.;Keck, Paul E., Jr.;L'Italien, Gilbert J.
背景：尽管非典型抗精神病药物已被广泛用作新的心境稳定剂，但双相情感障碍患者中药物相关性糖尿病的发病尚未得到充分的量化。目的：量化非典型抗精神病药物与糖尿病的关系。方法：采用1998年1月1日至2002年12月31日美国管理医疗机构的医疗索赔数据库进行了一项回顾性的、基于人群的病例对照研究。920例糖尿病病例与5258例对照按年龄、性别和双相情感指数月和年相匹配。糖尿病病例是通过诊断ICD-9代码或糖尿病药物来识别的。糖尿病患者至少有3个月的时间接触任何药物或至少3张治疗躁郁症或合并症的处方。结果：在920例患者中，41%接受了非典型抗精神病药物治疗(如奥氮平、利培酮、奎硫平、齐拉西酮、氯氮平)，34%接受了常规抗精神病药物治疗。与接受常规抗精神病药物的患者相比，服用氯氮平(风险比[HR]=7.0，95%可信区间[CI]=1.7至28.9)、利培酮(HR=3.4，95%CI=2.8至4.2)、奥氮平(HR=3.2，95%CI=2.7至3.8)和奎硫平(HR=1.8，95%CI=1.4至2.4)的患者患糖尿病的风险最大，并控制了年龄、性别、随访时间；锂、抗惊厥药、抗抑郁药或伴随药物的使用；以及精神和内科合并症。结论：双相患者使用抗精神病药物与糖尿病的发展或恶化有关。代谢并发症是接受抗精神病药物治疗的患者的一个主要问题。因此，在为双相情感障碍患者选择药物时，应考虑抗精神病药物诱发糖尿病的倾向。
Background: Drug-induced diabetes onset has not been adequately quantified in patients with bipolar disorder, although atypical antipsychotics have been widely used as new mood stabilizers.Objectives: To quantify the association between atypical antipsychotics and diabetes mellitus.Method: A retrospective, population-based, case-control study was conducted using the medical claims database from U.S. managed care organizations from January 1, 1998, to December 31, 2002. Nine hundred twenty incident cases of diabetes were matched with 5258 controls by age, sex, and bipolar index month and year. Diabetes cases were identified by either diagnosis of ICD-9 codes or diabetic medications. Patients with diabetes had a minimum 3-month exposure to any medications or at least 3 prescriptions for their bipolar or comorbidity treatment. Cox proportional hazard regression was conducted to assess the risk of diabetes associated with antipsychotic use.Results: Of 920 cases, 41% received atypical antipsychotics (e.g., olanzapine, risperidone, quetiapine, ziprasidone, clozapine) and 34% received conventional antipsychotics. Compared to patients receiving conventional antipsychotics, the risk of diabetes was greatest among patients taking clozapine (hazard ratio [HR] = 7.0, 95% confidence interval [CI] = 1.7 to 28.9), risperidone (HR = 3.4, 95% CI = 2.8 to 4.2), olanzapine (HR = 3.2, 95% CI = 2.7 to 3.8), and quetiapine (HR = 1.8, 95% CI = 1.4 to 2.4), with controlling covariates of age; sex; duration of follow-up; use of lithium, anticonvulsants, antidepressants, or concomitant drugs; and psychiatric and medical comorbidities.Conclusion: Development or exacerbation of diabetes mellitus is associated with antipsychotic use in bipolar patients. Metabolic complications are a major issue in patients receiving antipsychotic therapy. Thus, the propensity of an antipsychotic to induce diabetes should be a consideration when selecting an agent for patients with bipolar disorder.