A Regional Comparison of Developing Diabetes among VA Patients Exposed to Typical and Atypical Antipsychotics Relative to Corticosteroids and Proton Pump Inhibitors

Abstract

Metabolic changes, including weight gain and onset of diabetes, have been associated with both systemic corticosteroid use and atypical antipsychotic drugs. The purpose of this study was to quantify and compare the risk of new-onset diabetes mellitus in a Veterans Affairs population receiving antipsychotics and corticosteroids, using persons taking proton pump inhibitors as a control group. This study included data from subjects treated within Veterans Integrated Service Network 23 who had received an outpatient prescription in fiscal years (FY) 1999 or 2000 for a corticosteroid (CS), a proton pump inhibitor (PPI), a typical antipsychotic, or an atypical antipsychotic. Patients receiving prescriptions in more than one class were not excluded. Subjects were excluded if they had a documented diagnosis of diabetes either in the previous FY year (1998) or prior to their index prescription date. Thirteen percent of the population had a new diagnosis for diabetes during the two-year study. Cox-regression analysis using time dependent covariates determined a significantly higher risk of developing diabetes (RR = 1.21) in users of CS relative to PPIs. Demographic variables including age, race, gender, marital status, and VA financial classification as well as a marker for schizophrenia, were also included in the model. Comparison of both typical and atypical antipsychotics to PPIs found an increased but nonsignificant risk of developing diabetes (RR = 1.18 and RR = 1.19 respectively). The diabetogenic risk associated with atypical antipsychotics was found to be less than that of corticosteroids when compared to controls. Periodic monitoring of blood glucose should be considered with chronic use of an agent from either class.