Summary:
Antipsychotic medications are widely prescribed to children and adolescents, often for conditions such as autism-related irritability, attention-deficit/hyperactivity disorder, anxiety, and sleep difficulties rather than psychotic disorders. Research has linked antipsychotic use in young people with an increased risk of type 2 diabetes (T2D), with studies reporting a two to three fold higher risk compared with those unexposed. This population-based cohort study investigated changes in the prevalence of T2D before and after antipsychotic treatment in children and adolescents. The study included 89,991 young people aged 0-19 years who commenced antipsychotic treatment between 2006 and 2022. The study found that T2D prevalence remained stable before antipsychotic treatment but risk increased following treatment, particularly during the first year of treatment and continued to rise over the next five years. Larger increases in risk were observed among females and adolescents aged 13-19 years. Overall, the findings suggest that antipsychotic treatment in youth is associated with a sustained increase in T2D risk. This study highlights the importance of routine metabolic monitoring and early preventive measures for children and adolescents prescribed antipsychotic medications.
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Abstract:
Importance Antipsychotic medications are widely prescribed to children and adolescents worldwide, raising concerns about treatment-emergent type 2 diabetes (T2D). Previous studies have reported elevated T2D risks but have relied on between-person comparisons susceptible to unmeasured confounding and have not characterized risk trajectories around treatment initiation. Objective To determine the annual prevalence of pharmacologically treated T2D before and after antipsychotic initiation in Dutch youths. Design, Setting, and Participants This cohort study used data from Dutch population-based registers to track yearly pharmacologically treated T2D prevalence up to 5 years before and after antipsychotic initiation among youths aged 0 to 19 years initiating such medication. Using fixed-effects models, the event study design controlled for all stable, person-specific confounders that limit standard between-person comparisons. Data were collected from January 1, 2006, to December 31, 2022, and analyzed beginning in February 2025. Exposure Antipsychotic initiation (first recorded dispensation). Main Outcome and Measures The primary outcome was annual prevalence of pharmacologically treated T2D, defined as at least 1 dispensation of a noninsulin glucose-lowering medication within a given year. Annual risk differences (RDs) and relative risk changes were estimated using the year preceding antipsychotic initiation as the reference. Results A total of 89 991 youths who were dispensed at least 1 antipsychotic prescription between 2006 and 2022 (median [IQR] age at antipsychotic initiation, 13.6 [9.8-16.7] years; 55 794 [62.0%] males) were included in the sample. In this cohort, pharmacologically treated T2D prevalence was stable before treatment and increased significantly after antipsychotic initiation. The RD increased from 2.47 (95% CI, 1.09-3.86) per 10 000 antipsychotic users in the initiation year to 9.02 (95% CI, 5.99-12.06) per 10 000 users by year 5. Females had greater absolute excess risk of T2D than males by year 5 (RD, 16.48 [95% CI, 8.95-24.00] per 10 000 users vs 5.50 [95% CI, 2.57-8.43] per 10 000 antipsychotic users). Adolescents aged 13 to 19 years had a larger long-term increase in risk than children aged 7 to 12 years (year-5 RD, 14.09 [95% CI, 8.19-19.98] per 10 000 users vs 5.47 [95% CI, 2.76-8.18] per 10 000 users). While recurrent users experienced greater, progressively increasing risk (RD, 10.17 [95% CI, 6.47-13.87] per 10 000 antipsychotic users by year 5), elevated risk of pharmacologically treated T2D persisted among youths using antipsychotics in the initiation year only. Conclusions and Relevance In this within-individual cohort study, antipsychotic initiation in youths was associated with a rapid, sustained increase in treated T2D risk independent of underlying time-invariant factors. These findings indicate that even brief antipsychotic exposure is associated with a sustained metabolic vulnerability, underscoring the need for routine metabolic monitoring and preventive strategies from antipsychotic treatment initiation
Article Publication Date: 27/07/2026
DOI: 10.1001/jamanetworkopen.2026.25377
