Atypical antipsychotics and the risk of diabetes in an elderly population in long-term care: a retrospective nursing home chart review study

J Am Med Dir Assoc. 2009 Feb;10(2):115-9. doi: 10.1016/j.jamda.2008.08.005. Epub 2008 Dec 20.

Abstract

Objectives: Although atypical antipsychotics (AA) are associated with weight gain and diabetes mellitus (DM) in younger patients, it is not known whether these drugs would have a detrimental effect on weight gain or diabetes in a long-term care elderly population.

Design: Retrospective chart review.

Setting: Two community nursing homes (NH).

Participants: Charts of 1678 subjects admitted between 2000 and 2006 were screened; data from subjects on AA were analyzed.

Measurements: DM was defined by diagnosis in the Minimum Data Set (MDS), the prescription of diabetes medications, fasting blood glucose (BG) 126 mg/dL or higher, or random BG 200 mg/dL or higher. Worsening of DM was defined as beginning a medication in those treated with diet alone, or adding an additional medication to those already on antiglycemic therapy.

Results: There were 154 subjects on AA, mean age 82.8 +/- 8.0 (SD) years. Although there was no difference in age between the 101 women and the 53 men, there was a greater proportion of women 85 years or older compared with men (57% versus 40%, P = .04). Alzheimer's disease (AD) was diagnosed in 17% and non-AD dementia in 34%. Weight was normal (BMI less than 25 kg/m(2)) in 63%, overweight (BMI higher than 25 but less than 30 kg/m(2)) in 29%, and obese (BMI higher than 30 kg/m(2)) in 8%. Subjects were followed on AA for a median of 13.1 weeks (interquartile range 1.9-41.9). Despite these medications, 32% lost more than 5% of body weight. DM was an admitting diagnosis in 21%. There were 4 new and 5 worsening cases of DM during their stay in the nursing home; however, of these 9 cases, 4 occurred before the institution of AA. There was no increased frequency of weight gain or DM among the various atypical agents.

Conclusions: In an elderly NH population, there was no evidence that short-term use (median 13.1 weeks) of atypical antipsychotic agents was associated with the onset or worsening of DM.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / pharmacology
  • Antipsychotic Agents / therapeutic use
  • Diabetes Mellitus / chemically induced*
  • Female
  • Humans
  • Male
  • Medical Audit
  • Nursing Homes*
  • Retrospective Studies
  • Risk Assessment
  • Weight Gain / drug effects

Substances

  • Antipsychotic Agents