Research scientist Dr. Lorraine Lipscombe, MD, MSc, FRCPC is a staff physician in the Division of Endocrinology and Metabolism at Women's College Hospital and an Assistant Professor at the Department of Medicine at the University of Toronto. Other areas of research include medication safety in seniors with diabetes, and trends in diabetes prevalence.
“These drugs are associated with a worsening of diabetes symptoms, and physicians and patients need to be aware of these risks,” said Lorraine Lipscombe, a scientist at the Women's College Research Institute in Toronto and principal investigator for the study. The researcher said that “options other than antipsychotic drugs” should be considered for seniors with diabetes and symptoms of dementia.
Dr. Lipscombe said the study did not look at the appropriateness of prescribing antipsychotics to seniors – a subject of fierce debate – but she said that if these drugs are prescribed, blood sugar levels should be closely monitored so side effects can be treated.
The study involved 13,817 patients with diabetes – and an average age of 75 – who started taking antipsychotics between 2002 and 2006.
A total of 1,515 participants, or one in nine, were treated in hospitals for hyperglycemia (abnormally high blood sugar) during the study period.
Over all, those who took antipsychotics routinely had a 50 per cent higher risk of needing hospital treatment for high blood sugar than those who had discontinued treatment.
But one of the most notable findings was that the risk of hospitalization was up to 15 times higher just after patients began treatment with antipsychotics.
“There is a substantial risk associated with first-time use,” Dr. Lipscombe said. “But there is also an ongoing effect.”
The research showed that the level of risk posed by antipsychotics varied depending on a patient's method of treating their diabetes.
One in every 21 patients treated with insulin was hospitalized for hyperglycemia, compared with one in 42 who took drugs that bolster insulin; one in every 37 patients whose diabetes was untreated ended up at hospitals with hyperglycemia after taking antipsychotics.
Hyperglycemia can be dangerous if untreated: It can cause severe dehydration, blood poisoning, coma and heart attack.
Dr. Lipscombe cautioned that, while the new data are compelling, the precise impact of prescription drugs in seniors with multiple, chronic health conditions can be difficult to study.
Among the participants in this study, for example, 48 per cent had 20 or more prescriptions a year and 42 per cent had between 10 and 19 prescriptions. All of the study participants had diabetes, while 42 per cent suffered from dementia and 26 per cent had been diagnosed with schizophrenia.
It is well established that patients with schizophrenia who take antipsychotics over a long period of time have a much higher risk of developing diabetes – in large part because these drugs can cause substantial weight gain.
But the new research suggests the drugs can trigger immediate changes in blood sugar levels. The exact biological mechanism is unknown, but antipsychotic drugs inhibit the production of dopamine in the brain and dopamine also plays a role in controlling blood glucose.
A number of health warnings about antipsychotic drugs have been issued in recent years, most related to a higher risk of heart disease and stroke.
Even so, prescriptions continue to increase. There was a 20-per-cent jump in prescription of antipsychotics for the treatment of dementia between 2002 and 2007.[rc]
© Copyright 2009 CTVglobemedia Publishing Inc
July 28, 2009
CANADA: Antipsychotics pose high risks for older diabetics
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TORONTO, Ontario / Globe and Mail / Globe Life / Health & Fitness / July 28, 2009
DEMENTIA: Patients were up to 15 times more likely to need hospital treatment for elevated blood sugar if new to the medications
By André Picard, Public Health Reporter
Diabetic seniors on newly prescribed antipsychotic medications have up to 15 times the risk of being hospitalized for dangerously high blood-sugar levels as diabetics not taking the powerful drugs, new Canadian research shows.
The study, published in today's edition of the Archives of Internal Medicine, suggests that antipsychotic drugs – originally used to treat schizophrenia, but increasingly prescribed for dementia – can trigger sudden and potentially fatal changes in blood glucose.
The medication can also make it more difficult to control diabetes symptoms over time, particularly in people over 65 – who represent close to half of those with diabetes.
Research scientist Dr. Lorraine Lipscombe, MD, MSc, FRCPC is a staff physician in the Division of Endocrinology and Metabolism at Women's College Hospital and an Assistant Professor at the Department of Medicine at the University of Toronto. Other areas of research include medication safety in seniors with diabetes, and trends in diabetes prevalence.
“These drugs are associated with a worsening of diabetes symptoms, and physicians and patients need to be aware of these risks,” said Lorraine Lipscombe, a scientist at the Women's College Research Institute in Toronto and principal investigator for the study. The researcher said that “options other than antipsychotic drugs” should be considered for seniors with diabetes and symptoms of dementia.
Dr. Lipscombe said the study did not look at the appropriateness of prescribing antipsychotics to seniors – a subject of fierce debate – but she said that if these drugs are prescribed, blood sugar levels should be closely monitored so side effects can be treated.
The study involved 13,817 patients with diabetes – and an average age of 75 – who started taking antipsychotics between 2002 and 2006.
A total of 1,515 participants, or one in nine, were treated in hospitals for hyperglycemia (abnormally high blood sugar) during the study period.
Over all, those who took antipsychotics routinely had a 50 per cent higher risk of needing hospital treatment for high blood sugar than those who had discontinued treatment.
But one of the most notable findings was that the risk of hospitalization was up to 15 times higher just after patients began treatment with antipsychotics.
“There is a substantial risk associated with first-time use,” Dr. Lipscombe said. “But there is also an ongoing effect.”
The research showed that the level of risk posed by antipsychotics varied depending on a patient's method of treating their diabetes.
One in every 21 patients treated with insulin was hospitalized for hyperglycemia, compared with one in 42 who took drugs that bolster insulin; one in every 37 patients whose diabetes was untreated ended up at hospitals with hyperglycemia after taking antipsychotics.
Hyperglycemia can be dangerous if untreated: It can cause severe dehydration, blood poisoning, coma and heart attack.
Dr. Lipscombe cautioned that, while the new data are compelling, the precise impact of prescription drugs in seniors with multiple, chronic health conditions can be difficult to study.
Among the participants in this study, for example, 48 per cent had 20 or more prescriptions a year and 42 per cent had between 10 and 19 prescriptions. All of the study participants had diabetes, while 42 per cent suffered from dementia and 26 per cent had been diagnosed with schizophrenia.
It is well established that patients with schizophrenia who take antipsychotics over a long period of time have a much higher risk of developing diabetes – in large part because these drugs can cause substantial weight gain.
But the new research suggests the drugs can trigger immediate changes in blood sugar levels. The exact biological mechanism is unknown, but antipsychotic drugs inhibit the production of dopamine in the brain and dopamine also plays a role in controlling blood glucose.
A number of health warnings about antipsychotic drugs have been issued in recent years, most related to a higher risk of heart disease and stroke.
Even so, prescriptions continue to increase. There was a 20-per-cent jump in prescription of antipsychotics for the treatment of dementia between 2002 and 2007.[rc]
© Copyright 2009 CTVglobemedia Publishing Inc
Research scientist Dr. Lorraine Lipscombe, MD, MSc, FRCPC is a staff physician in the Division of Endocrinology and Metabolism at Women's College Hospital and an Assistant Professor at the Department of Medicine at the University of Toronto. Other areas of research include medication safety in seniors with diabetes, and trends in diabetes prevalence.
“These drugs are associated with a worsening of diabetes symptoms, and physicians and patients need to be aware of these risks,” said Lorraine Lipscombe, a scientist at the Women's College Research Institute in Toronto and principal investigator for the study. The researcher said that “options other than antipsychotic drugs” should be considered for seniors with diabetes and symptoms of dementia.
Dr. Lipscombe said the study did not look at the appropriateness of prescribing antipsychotics to seniors – a subject of fierce debate – but she said that if these drugs are prescribed, blood sugar levels should be closely monitored so side effects can be treated.
The study involved 13,817 patients with diabetes – and an average age of 75 – who started taking antipsychotics between 2002 and 2006.
A total of 1,515 participants, or one in nine, were treated in hospitals for hyperglycemia (abnormally high blood sugar) during the study period.
Over all, those who took antipsychotics routinely had a 50 per cent higher risk of needing hospital treatment for high blood sugar than those who had discontinued treatment.
But one of the most notable findings was that the risk of hospitalization was up to 15 times higher just after patients began treatment with antipsychotics.
“There is a substantial risk associated with first-time use,” Dr. Lipscombe said. “But there is also an ongoing effect.”
The research showed that the level of risk posed by antipsychotics varied depending on a patient's method of treating their diabetes.
One in every 21 patients treated with insulin was hospitalized for hyperglycemia, compared with one in 42 who took drugs that bolster insulin; one in every 37 patients whose diabetes was untreated ended up at hospitals with hyperglycemia after taking antipsychotics.
Hyperglycemia can be dangerous if untreated: It can cause severe dehydration, blood poisoning, coma and heart attack.
Dr. Lipscombe cautioned that, while the new data are compelling, the precise impact of prescription drugs in seniors with multiple, chronic health conditions can be difficult to study.
Among the participants in this study, for example, 48 per cent had 20 or more prescriptions a year and 42 per cent had between 10 and 19 prescriptions. All of the study participants had diabetes, while 42 per cent suffered from dementia and 26 per cent had been diagnosed with schizophrenia.
It is well established that patients with schizophrenia who take antipsychotics over a long period of time have a much higher risk of developing diabetes – in large part because these drugs can cause substantial weight gain.
But the new research suggests the drugs can trigger immediate changes in blood sugar levels. The exact biological mechanism is unknown, but antipsychotic drugs inhibit the production of dopamine in the brain and dopamine also plays a role in controlling blood glucose.
A number of health warnings about antipsychotic drugs have been issued in recent years, most related to a higher risk of heart disease and stroke.
Even so, prescriptions continue to increase. There was a 20-per-cent jump in prescription of antipsychotics for the treatment of dementia between 2002 and 2007.[rc]
© Copyright 2009 CTVglobemedia Publishing Inc
