Antipsychotic Use and the Risk of Diabetes in Nursing Home Residents with Dementia

Background

Growing evidence suggests an association between antipsychotic use and diabetes onset in schizophrenia, but little is known about this association among patients with dementia.

Objective

The aim of this study was to quantify the association between antipsychotic use and the risk of diabetes onset among nursing home residents with dementia.

Methods

We conducted a nested case-control study in 29,203 long-stay Medicaid-eligible residents living in nursing homes in California, Florida, Illinois, New York, and Ohio between January 2001 and December 2002 who were at least 65 years old with a dementia diagnosis and no record of diabetes within 90 days of nursing home admission. We identified 762 incident cases of diabetes and randomly selected up to 5 controls, matched on nursing home and quarter of minimum data set (MDS) assessment (N = 2646). Cases of incident diabetes were identified from MDS assessments and Medicaid claims, medication use was ascertained from Medicaid pharmacy files, and resident characteristics were obtained from MDS assessments.

Results

Relative to non-users of antipsychotics, use of atypical antipsychotics was not associated with diabetes onset (adjusted odds ratio [AOR] = 1.03; 95% CI, 0.84–1.27) and risk of diabetes did not increase with length of time on treatment. Conventional antipsychotic treatment was associated with diabetes onset, particularly when treatment duration was <30 days (AOR = 2.70; 95% CI, 1.57–4.65).

Conclusions

Among nursing home residents with dementia, conventional antipsychotic therapy, particularly short-term therapy, increased their risk of developing diabetes. Atypical antipsychotic use was not associated with an increased risk of diabetes onset.