Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients
Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients
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DOI：
10.1176/appi.ps.55.9.1006
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发表时间：
2004-09-01
影响因子：
3.8
通讯作者：
Robinson, J
中科院分区：
文献类型：
--
作者：
Citrome, L;Jaffe, A;Robinson, J
目的：本研究检查了大型州立医院系统中患有严重和持续性精神疾病的患者的数据，以确定服用第二代抗精神病药物的患者是否比服用第一代抗精神病药物的患者更容易患糖尿病。方法：采用病例对照研究设计。一种新的抗糖尿病药物处方被用来识别新的糖尿病病例。计算暴露于第二代抗精神病药物（氯氮平、利培酮、奥氮平、喹硫平和多种第二代抗精神病药物）与暴露于第一代抗精神病药物的比值比。病例和对照是通过使用包含纽约州心理健康办公室运营的住院设施中的药物处方信息的数据库来识别的。审查了2000年1月1日至2002年12月31日的数据。在 13,611 名接受抗精神病药物治疗的患者中，有 8,461 名患者符合住院至少 60 天且过去未服用过抗糖尿病药物的入院标准。其中 181 名住院患者在入院至少 30 天后收到了抗糖尿病药物处方。每个病例（N=181）有 8 个对照（N=1,448），按日历年、观察期长度、种族、年龄组和诊断进行匹配，总样本为 1,629 名患者。结果：与单独接受第一代抗精神病药物的患者相比，接受一种以上第二代抗精神病药物或氯氮平或喹硫平治疗的患者的风险显着升高。尽管没有统计学意义，但奥氮平和利培酮的比值比也有所升高。调整性别和年龄的条件逻辑回归并没有改变结果。结论：接触多种第二代抗精神病药物或氯氮平或喹硫平显着增加治疗中出现的糖尿病的风险。
Objective: This study examined data on patients with serious and persistent mental illness in a large state hospital system to determine whether patients who took second-generation antipsychotics were more likely to develop diabetes mellitus than patients who took first-generation antipsychotics. Methods: A case-control study design was used. A new prescription of an antidiabetic medication was used to identify new cases of diabetes mellitus. Odds ratios were calculated for exposure to second-generation antipsychotics (clozapine, risperidone, olanzapine, quetiapine, and multiple second-generation antipsychotics) compared with exposure to first-generation antipsychotics. Cases and controls were identified by using a database that contained drug prescription information from the inpatient facilities that were operated by the New York State Office of Mental Health. Data from January 1, 2000, to December 31, 2002, were examined. Among 13,611 unique patients who received antipsychotics, 8,461 met entry criteria of being hospitalized for at least 60 days and not having an antidiabetic medication prescribed in the past. A total of 181 of these inpatients received prescriptions for an antidiabetic medication at least 30 days after their admission. Eight controls (N=1,448) for each case (N=181) were matched by calendar year, length of observation period, race, age group, and diagnosis, giving a total sample of 1,629 patients. Results: Statistically significant elevations in risk were seen among patients who received more than one second-generation antipsychotic or clozapine or quetiapine, compared with patients who received first-generation antipsychotics alone. Although not statistically significant, odds ratios for olanzapine and risperidone were also elevated. Conditional logistic regression adjusting for gender and age did not change the results. Conclusions: Exposure to multiple second-generation antipsychotics or clozapine or quetiapine significantly increased the risk of treatment-emergent diabetes mellitus.