New-Onset Treatment-Dependent Diabetes Mellitus and Hyperlipidemia Associated with Atypical Antipsychotic Use in Older Adults without Schizophrenia or Bipolar Disorder

Sara C. Erickson PharmD1,*, Lisa Le MS1, Armen Zakharyan PhD1, Karen M. Stockl PharmD1, Ann S. M. Harada PhD, MPH1, Soo Borson MD2, Scott D. Ramsey MD, PhD3, Bradford Curtis MD1

Objectives

To examine the association between atypical antipsychotic medications and incident treatment for diabetes mellitus or hyperlipidemia in elderly adults without diagnoses of schizophrenia or bipolar disorder.

Design

Two case–control studies using medical and pharmacy claims data.

Setting

United States managed care population from multiple insurance plans.

Participants

Individuals aged 65 and older enrolled in a Medicare Advantage or commercial (health maintenance organization) managed care health plan in the western United States with no claims indicating diagnosis of schizophrenia or bipolar disorder in the 1 year pre-index period. Cases were defined as persons newly initiated on an antidiabetic (n = 13,075) or antihyperlipidemic (n = 63,829) medication on the index date. For the new diabetes mellitus analysis, 65,375 controls were matched to cases based on age, sex, health-plan type, and index date year. In the new hyperlipidemia analysis, 63,829 controls were matched to cases based on the same variables.

Measurements

Conditional logistic regressions were performed to determine the odds of initiated antidiabetic or antihyperlipidemic medication for participants exposed to atypical antipsychotics compared with those with no exposure. The models included comorbidities possibly associated with the outcome.

Results

Exposure to atypical antipsychotics was associated with significantly greater adjusted odds of starting an antidiabetic medication (1.32, 95% confidence interval (CI) = 1.10–1.59) but significantly lower odds of starting an antihyperlipidemic medication (0.76, 95% CI = 0.67–0.87).

Conclusion

Use of atypical antipsychotics in older adults for conditions other than schizophrenia and bipolar disorder was associated with incident treatment of diabetes mellitus but not of hyperlipidemia, suggesting that older adults may be susceptible to the adverse metabolic consequences of these agents.

Journal of the American Geriatrics Society

2012 DOI: 10.1111/j.1532-5415.2011.03842.x