Atypical antipsychotics are associated with incident diabetes in older adults without schizophrenia or bipolar disorder

ED FROM Erickson SC, Le L, Zakharyan A, et al. New-onset treatment-dependent diabetes mellitus and hyperlipidemia associated with atypical antipsychotic use in older adults without schizophrenia or bipolar disorder. J Am Geriatr Soc 2012;60:474–9. Correspondence to: Sara C Erickson, Sr. Outcomes Researcher, OptumRx, 2300 Main St. CA134-0404, Irvine, CA 92614, USA; sara.c.erickson@optum. comCorrespondence to: Sara C Erickson, Sr. Outcomes Researcher, OptumRx, 2300 Main St. CA134-0404, Irvine, CA 92614, USA; [email protected] Sources of funding Not reported. ▸ Notes and References are published online at http://ebmh.bmj.com OM M EN TRY Erickson et al used data from multiple insurance companies to examine the risk of diabetes mellitus and hyperlipidaemia in older adults without schizophrenia or bipolar disorder who received treatment with atypical antipsychotic agents. This is an important study as it highlights the risk of metabolic disturbances in older adults treated with these agents. It also provided evidence that the increased risk for diabetes is not associated with the psychiatric diagnosis, but more so with the atypical antipsychotic agents themselves. The findings contradict a previous, smaller retrospective study that found no increased risk for diabetes in older patients treated with these agents. The results seem to fit more with clinical observation, which contrasts previous reports. While the claims data methods used in this study have its limitations, the large sample size and comparison group increases its strength. The lack of an association with these agents and hyperlipidaemia is not surprising. The risk of hyperlipidaemia associated with the atypical antipsychotic agents lies mostly in their effects on insulin resistance which can impair lipid metabolism primarily through lowering highdensity lipoprotein cholesterol and increasing triglycerides. However, these two lipid abnormalities are less likely to result in the diagnosis of hyperlipidaemia or the recommendation of a lipid lowering drug. Even more so, the first-line treatment for elevated triglycerides is commonly the recommendation of diet and ω-3 fatty acid treatment such as fish oil and does not necessitate a prescription. The results of this study should inform clinicians of the need for close monitoring for diabetes mellitus in patients treated with these agents. Though difference between agents was not observed, the study highlights the importance of monitoring all patients treated with atypical antipsychotic agents and that an advanced age is not protective from the metabolic effects. Neelam Thakurathi, David C Henderson Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston,