Atypical Antipsychotics and the Risk of Diabetes in an Elderly Population in Long-Term Care: A Retrospective Nursing Home Chart Review Study

Abstract

Although atypical antipsychotics (AA) are associated with weight gain and diabetes mellitus (DM) in younger patients, it is not known whether these drugs would have a detrimental effect on weight gain or diabetes in a long-term care elderly population. Retrospective chart review. Two community nursing homes (NH). Charts of 1678 subjects admitted between 2000 and 2006 were screened; data from subjects on AA were analyzed. DM was defined by diagnosis in the Minimum Data Set (MDS), the prescription of diabetes medications, fasting blood glucose (BG) 126 mg/dL or higher, or random BG 200 mg/dL or higher. Worsening of DM was defined as beginning a medication in those treated with diet alone, or adding an additional medication to those already on antiglycemic therapy. There were 154 subjects on AA, mean age 82.8 +/- 8.0 (SD) years. Although there was no difference in age between the 101 women and the 53 men, there was a greater proportion of women 85 years or older compared with men (57% versus 40%, P = .04). Alzheimer's disease (AD) was diagnosed in 17% and non-AD dementia in 34%. Weight was normal (BMI less than 25 kg/m(2)) in 63%, overweight (BMI higher than 25 but less than 30 kg/m(2)) in 29%, and obese (BMI higher than 30 kg/m(2)) in 8%. Subjects were followed on AA for a median of 13.1 weeks (interquartile range 1.9-41.9). Despite these medications, 32% lost more than 5% of body weight. DM was an admitting diagnosis in 21%. There were 4 new and 5 worsening cases of DM during their stay in the nursing home; however, of these 9 cases, 4 occurred before the institution of AA. There was no increased frequency of weight gain or DM among the various atypical agents. In an elderly NH population, there was no evidence that short-term use (median 13.1 weeks) of atypical antipsychotic agents was associated with the onset or worsening of DM.