Antipsychotic Drugs and Hyperglycemia in Older Patients With Diabetes
Antipsychotic Drugs and Hyperglycemia in Older Patients With Diabetes
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DOI：
10.1001/archinternmed.2009.207
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发表时间：
2009-07-27
影响因子：
--
通讯作者：
Rochon, Paula A.
中科院分区：
文献类型：
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作者：
Lipscombe, Lorraine L.;Levesque, Linda;Rochon, Paula A.
背景：有证据表明抗精神病药物与新发糖尿病之间存在关联，但对既往糖尿病患者中的高血糖风险知之甚少。方法：采用嵌套病例对照设计和加拿大安大略省基于人群的健康数据库，从2002年4月1日至2006年3月31日对66岁或以上的糖尿病患者进行了从治疗开始到2007年3月31日的跟踪调查。队列再分为3组：胰岛素治疗组、单纯口服降糖药治疗组和不治疗糖尿病组。我们将病例定义为因高血糖而住院(急诊科就诊或住院)的患者。每个病例与最多10个对照组相匹配。基于最接近事件日期的处方，我们比较了非典型和典型抗精神病药物的当前使用者和远程抗精神病药物使用者(停用180天)发生高血糖的可能性。结果：在13817名患者中，1515人(11.0%)因高血糖而住院。在所有糖尿病治疗组中，当前的抗精神病药物治疗与远程使用抗精神病药物相比，高血糖的风险更高(总体调整后的比率为1.50；95%可信区间为1.29-1.74)。在接受非典型和典型抗精神病药物治疗的患者中，风险增加，而在刚刚开始治疗的患者中风险极高(事件前只有1张处方)。结论：在老年糖尿病患者中，开始使用抗精神病药物与因高血糖而住院的风险显著增加(P<；.001)。在最初的治疗过程中，风险特别高，并且随着所有抗精神病药物的使用而增加。
Background: Evidence suggests that there is an association between antipsychotic drugs and new-onset diabetes, but little is known about the risk of hyperglycemia among persons with preexisting diabetes.Methods: Using a nested case-control design and population-based health databases in Ontario, Canada, persons aged 66 years or older with diabetes who started treatment with an antipsychotic drug from April 1, 2002, to March 31, 2006, were followed up from treatment start until March 31, 2007. The cohort was subdivided into 3 groups: insulin-treated, oral hypoglycemic agent only treated, and no diabetes treatment. We defined cases as patients hospitalized (emergency department visit or hospital admissions) for hyperglycemia. Each case was matched with up to 10 controls. We compared the likelihood of hyperglycemia among current users of atypical and typical antipsychotic agents with that among remote antipsychotic users (discontinued >180 days), based on prescriptions closest to event date.Results: Of 13 817 patients studied, 1515 (11.0%) were hospitalized for hyperglycemia. Current antipsychotic treatment was associated with a higher risk of hyperglycemia compared with remote antipsychotic use in all diabetes treatment groups (overall adjusted rate ratio, 1.50; 95% confidence interval, 1.29-1.74). The risk was increased among patients who were treated with atypical and typical antipsychotic agents and was extremely high among patients who were just starting treatment (only 1 prescription before event).Conclusions: Among older patients with diabetes, the initiation of treatment with antipsychotic drugs was associated with a significantly increased risk of hospitalization for hyperglycemia (P < .001). The risk was particularly high during the initial course of treatment and was increased with the use of all antipsychotic agents.