Psychotropic Classes Concomitant with Stimulants and the Association with the Risk of Diabetes in Medicaid-Insured
Yue Zhu1, Julie M Zito2,3, James F Gardner2
1Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
Importance:
Psychotropic classes concomitant with stimulants (PCCWS) in children and adolescents have shown an inconsistent impact on the risk of diabetes mellitus. PCCWS with 2-5 classes is common but the risk of diabetes subsequent to stimulant initiation is unknown.
Objective:
To assess the risk of diabetes in youth with PCCWS regimens with 2-5 additional psychotropic classes.
Design:
A retrospective cohort study was conducted using Medicaid claims data from 2007-2014. Youth aged 2-17 years with 1-7.5 years of continuous enrollment who were new stimulant users with clinician-reported psychiatric diagnosis were followed.
Setting:
Outpatient clinic and inpatient records for statewide Medicaid-insured youth in a mid-Atlantic state.
Participants:
The study cohort comprised 30,112 youth with an average follow-up of 6.4 years.
Exposures:
Among stimulant users, five groups were defined according to concomitant use.
Main Outcomes And Measures:
The major outcome is diabetes risk and was assessed using discrete-time failure models, after adjustment for disease risk score which was categorized using more than 120 baseline and time-dependent covariates.
Results:
Among 30,112 new stimulant users, 43 were new diabetes patients and 30,069 were nondiabetes patients. The absolute risk of diabetes in youth had an eight-fold increase from 3 to 5 class PCCWS regimens that included antipsychotics, antidepressants, or anticonvulsant-mood stabilizers (0.5; 1.13; 4.20 per 10,000 person-months, respectively). Compared with stimulant monotherapy, PCCWS with any of these 3 classes were significantly more likely to develop diabetes (adjusted relative risk [ARR], 2.58, (95% CI 1.05-6.82); 5.81, (2.29-14.75); 18.91, (6.07-58.90) for 3, 4 and 5 class PCCWS, respectively). Similarly, there was a significantly greater risk of diabetes for those with 120-779 days of cumulative duration than for shorter exposures, and in 4 and 5 class combined PCCWS including antipsychotics, antidepressants, or anticonvulsant-mood stabilizers [ARR, 3.78, (1.16-12.40)].
Conclusions:
In a large Medicaid-insured, long-enrolled youth cohort, the use of PCCWS, particularly concomitant use with antipsychotic, antidepressant, and/or antipsychotic-mood stabilizers, and with long duration of these combinations were associated with an increased risk of diabetes.
Relevance:
The findings support a call for corroboration in a large national cohort of continuously enrolled Medicaid-insured pediatric youth with long follow-up.
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