Antipsychotic Drugs Associated With High Blood Sugar in Older Adults With Diabetes

Older patients with diabetes who take antipsychotic medications appear to have an increased risk of hospitalization for hyperglycemia (elevated blood glucose level), especially soon after beginning treatment, according to a report in the July 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

An increasing number of older adults are being prescribed antipsychotic drugs for dementia and other conditions, according to background information in the article. However, these medications may be associated with a—including Parkinson’s disease symptoms, stroke and diabetes—in the older population. “The risk of diabetes may be partly related to chronic effects of the weight gain associated with antipsychotic agents,” the authors write. “However, case reports of acute hyperglycemia after the initiation of therapy with these drugs suggest that they may also be associated with acute glycemic [blood glucose level] changes.”

Lorraine L. Lipscombe, M.D., M.Sc., of the Institute for Clinical Evaluative Sciences, University of Toronto and Women’s College Research Institute at Women’s College Hospital, Toronto, Ontario, Canada, and colleagues studied 13,817 individuals age 66 and older (average age 78) with diabetes who began treatment with antipsychotics between April 1, 2002, and March 31, 2006. Each patient who was hospitalized for hyperglycemia during the observation period—through March 31, 2007, an average of two years of follow-up—was considered a case and was matched with up to 10 control patients who were the same age and sex but were not hospitalized over the same time period. The researchers then compared the likelihood of hyperglycemia among those who were currently taking antipsychotic medications to those who had discontinued antipsychotic medications for more than 180 days.

Of the total group of 13,817 patients, 1,515 (11 percent) were hospitalized for hyperglycemia. Those who were currently taking antipsychotic drugs had a higher risk of hospitalization than those who had stopped the medications more than 180 days ago. The risk was highest among those who were just starting antipsychotic drug treatment.

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Antipsychotic Use in Elders With Alzheimer's Leads to Large Increase in Mortality

There is a large increased long-term risk of mortality in patients with Alzheimer's disease (AD) who are prescribed antipsychotic medication, according to the long-term follow-up results of the Dementia Antipsychotic Withdrawal Trial (DART-AD) published early online and in the February edition of The Lancet Neurology.

While there is evidence of modest short term benefits of antipsychotic treatment for the neuropsychiatric symptoms of AD, there is also clear evidence of an increase in adverse effects. However, all the data regarding mortality so far relate to short term follow-up of 12 weeks or less.

Clive Ballard, MD, Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom, and colleagues have provided the first long-term follow-up data for AD patients given antipsychotic drugs.

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Deep Brain Stimulation Helps Those With Advanced Parkinson's Study found both physical function and quality of life improved

The largest study of its kind finds that deep brain stimulation improves both physical function and quality of life after six months in patients with Parkinson's disease.

Deep brain stimulation (DBS) performed better than currently available drug treatments, but it did carry some risks, including one death, according to a study in the Jan. 7 issue of the Journal of the American Medical Association.

"This basically corroborates what has largely emerged over the last decade from literature and clinical experience showing pretty dramatically the potential benefit of DBS for Parkinson's," said Dr. Fred Marshall, medical director of the deep brain stimulation program at the University of Rochester Medical Center, in New York.

Despite abundant clinical experience, there have been few controlled trials on the topic, added colleague Dr. Irene Richard, an associate professor of neurology and psychiatry at the University of Rochester Medical Center. "This is corroborative, that surgery is helpful, but it is associated with more risk."

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