Treatment with antipsychotics and the risk of diabetes in clinical practice
Open accessAbstract
Background: Treatment with antipsychotics seems to increase the risk of developing diabetes but the association is poorly characterised in clinical practice. Aims: To investigate and characterise the incidence of diabetes for people treated with antipsychotic medication in clinical practice. Method: The study used the linkage of registers of all prescribed antipsychotics, antidiabetics and diagnoses of diabetes in Denmark during a period from 1996 to 2005 and identified all people treated with antipsychotics in Denmark and a random sample of about 30% of the total Danish population. Results: In total, 345 937 patients who purchased antipsychotics and 1 426 488 unexposed individuals were included in the study. Among the total population, 50 379 individuals subsequently developed incident diabetes. Compared with unexposed individuals, treatment with first- (rate ratio, RR = 1.53, 95% CI 1.49–1.56) as well as second-generation (RR = 1.32, 95% CI 1.22–1.42) antipsychotics was associated with increased risk of subsequent incident diabetes. The rate of incident diabetes varied substantially between individual second-generation antipsychotic drugs (olanzapine, risperidone clozapine compared with unexposed individuals: low to moderate rate ratio between 1.17 and 1.57; ziprasidone and sertindol: two or more times increased rate ratio; amisulpride, quetiapine and aripiprazole: no significantly increased rate ratio). For both first- and second-generation antipsychotics, the incidence of diabetes increased with the number of prescriptions. Additionally, the incidence of diabetes increased with the number of combined antipsychotic drugs. Conclusions: In clinical practice, treatment with first- and second-generation antipsychotics is associated with an increased risk of developing incident diabetes with large differences between individual drugs. The risk increases with the duration of treatment and with polypharmacy of antipsychotic drugs.
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Variations in the risk for glucose abnormalities are evident in the literature, with the highest risk being associated with clozapine, olanzapine and quetiapine in carefully designed studies.
“Variations in the risk for glucose abnormalities are evident in the literature, with the highest risk being associated with clozapine, olanzapine and quetiapine in carefully designed studies 25,34,35 .”
From Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis (2016) · cites this paper as [35]
Antipsychotics with lower cardiometabolic risk profiles in short-term studies are often prescribed for higher risk patients in clinical care, which may lead to a not reduced or even increased cardiometabolic risk in naturalistic settings.
“antipsychotics with lower cardiometabolic risk profiles in short-term studies are often prescribed for higher risk patients in clinical care, which may lead to a not reduced or even increased cardiometabolic risk in naturalistic settings (42).”
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- Authors
- Kessing, L. V., Thomsen, A. F., Mogensen, U. B., & Andersen, P. K.
- Affiliations
- Copenhagen University Hospital (DK)
- University of Copenhagen (DK)
- Corresponding author
- Kessing, Lars Vedel
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2010-10
- Volume
- 197
- Issue
- 4
- Pages
- 266-271
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2117234502
- Cited by
- 152
- References
- 26
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 5 · 2021: 8 · 2020: 6 · 2019: 12 · 2018: 17 · 2017: 8 · 2016: 10 · 2015: 13 · 2014: 11 · 2013: 8 · 2012: 18
- FWCI
- 9.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- antipsychotic drugs, diabetes mellitus, new-onset diabetes, atypical antipsychotics, typical antipsychotics, olanzapine, risperidone, clozapine, ziprasidone, sertindole, amisulpride, quetiapine, aripiprazole, polypharmacy, treatment duration, drug safety
- MeSH terms
- Adult, Aged, Blood Glucose, Denmark, Diabetes Mellitus, Epidemiologic Methods, Female, Humans, Hypoglycemic Agents, Male, Middle Aged, Drug Prescriptions, Antipsychotic Agents, Sex Distribution, Pharmacoepidemiology, Polypharmacy, Young Adult
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