A comprehensive Dutch cohort study reveals a sharp, sustained increase in type 2 diabetes among children and adolescents following antipsychotic treatment, prompting calls for routine metabolic monitoring and preventive measures in young patients.
A large Dutch cohort study has found that starting antipsychotic treatment in children and adolescents was followed by a sharp, sustained rise in pharmacologically treated type 2 diabetes, adding to long-standing concerns about the metabolic effects of these drugs in younger patients.
Researchers tracked 89,991 people aged 0 to 19 using national registry data from 2006 to 2022, comparing each patient with themselves over five years before and five years after their first antipsychotic prescription. According to the JAMA Network Open paper, diabetes prevalence was low and largely flat before treatment, but increased after initiation from 6.22 cases per 10,000 users in the treatment year to 14.58 per 10,000 by year five, with no meaningful pre-treatment trend to suggest the rise had already begun.
The excess risk was not evenly distributed. By five years, the increase was markedly higher among girls than boys, and adolescents aged 13 to 19 accumulated more excess risk than children aged 7 to 12. The study also found that even those exposed only in the first year still had elevated risk later on, while recurring users saw a steeper climb, leading the authors to warn that early metabolic changes may not fully reverse in some young people.
The findings fit with earlier evidence that antipsychotics can worsen glucose regulation through several pathways. A review in Current Diabetes Reports in 2019 said diabetes is far more common among people with severe mental illness and noted that some second-generation antipsychotics can drive insulin resistance and impair pancreatic insulin secretion. Research from the University of Toronto has also suggested that these drugs may interfere with the brain’s glucose-sensing systems, providing another possible explanation for the rise in blood sugar risk.
The Dutch authors said their outcome probably undercounts the true burden of diabetes because it captures only cases treated with medication, not undiagnosed or diet-managed disease. They also could not separate the effects of individual antipsychotic drugs, which previous research suggests differ in risk. Even so, they called for routine metabolic monitoring from the start of treatment, alongside early preventive steps such as dietary advice and support for physical activity. Pharmacy specialists, too, are increasingly seen as part of that response, with a 2023 commentary in the International Journal of Clinical Pharmacy arguing that pharmacists can help counsel patients, flag adverse effects and reinforce screening between psychiatric appointments.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
