Risk of Hospitalization for Hypoglycemia in Older Patients with Diabetes Using Antipsychotic Drugs

• Published in: The American journal of geriatric psychiatry Vol. 23; no. 11; pp. 1144 - 1153
• Main Authors: van Keulen, Kris, Pharm.D, van der Linden, Paul D., Ph.D, Souverein, Patrick C., Ph.D, Heerdink, Eibert R., Ph.D, Egberts, Antoine C.G., Ph.D, Knol, Wilma, Ph.D
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-11-2015
• Subjects: Aged; Aged, 80 and over; Antipsychotic Agents - adverse effects; antipsychotic drugs; Case-Control Studies; Diabetes Complications - chemically induced; Diabetes Complications - epidemiology; Diabetes Complications - psychology; diabetes mellitus; Female; Hospitalization - statistics & numerical data; Humans; hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - epidemiology; Internal Medicine; Logistic Models; Male; Netherlands - epidemiology; Older patients; Risk Factors; Netherlands; Older patients; diabetes mellitus; antipsychotic drugs; hypoglycemia
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2015.04.006

Objective Antipsychotics may disrupt metabolic regulation in patients with diabetes mellitus. The risk of hypoglycemia in older users of antipsychotics with diabetes is largely unknown. Therefore, we investigated the association between the use of antipsychotic drugs and hypoglycemia requiring hospital admission in older patients with diabetes. Methods In a nested case-control study using community pharmacy records linked to hospital admission data in the Netherlands (1998–2008), a cohort of 68,314 patients at least 65 years with diabetes was studied. Cases were patients from the study cohort with a first hospital admission for hypoglycemia; up to five comparison subjects were selected for each case. Exposure to antipsychotic drugs was the primary determinant of interest. Logistic regression analysis was performed to estimate the strength of the association between antipsychotic drug use and hypoglycemia, taking into account potential confounders. Results Eight hundred fifteen patients were admitted to hospital for hypoglycemia. Current use of antipsychotic drugs was associated with an increased risk of hypoglycemia compared with non-use (adjusted OR: 2.26; 95% CI: 1.45–3.52; Wald χ2  = 13.08, df = 1, p ≤0.001), especially in the first 30 days of treatment (adjusted OR: 7.65; 95% CI: 2.50–23.41; Wald χ2  = 12.72, df = 1, p ≤0.001) and with higher doses (adjusted OR: 8.20; 95% CI: 3.09–21.75; Wald χ2  = 17.90, df = 1, p ≤0.001). Conclusion Use of antipsychotic drugs by older patients with diabetes mellitus was associated with an increased risk of hospitalization for hypoglycemia. Our findings suggest that glucose levels should be monitored closely after initiation of antipsychotic drugs.