Abstract
OBJECTIVE: Antipsychotic drug use is an established risk factor for the development of type 2 diabetes mellitus. However, the effect of antipsychotic drug on the progression of diabetes complications remains unclear. This study aimed to explore the association between antipsychotic treatment and advanced diabetes outcome among schizophrenia patients with type 2 diabetes. METHODS: The authors conducted a retrospective cohort study using Taiwan's universal health insurance database. A total of 17 629 schizophrenia patients with newly-diagnosed diabetes were enrolled. The mean duration of follow-up, after excluding the first 6-month observation period, was 4.8 years, ranged from 1 month to 11.5 years. Antipsychotic treatment patterns within a 6-month time window were classified into none, irregular use, and regular use. Antipsychotics were further categorized into the high, intermediate, and low metabolic risks. The status of exposure was treated as time-dependent variables. The outcomes measures included any advanced diabetes complications, macrovascular and microvascular complications, and all-cause mortality. RESULTS: Compared to no antipsychotic treatment in the past 6 months, regular antipsychotic use was associated with a lower risk of any advanced diabetes complications (adjusted hazard ratio, aHR = 0.81, 95% CI = 0.69-0.95), macrovascular complications (aHR = 0.80, 95% CI = 0.66-0.97), and all-cause mortality (aHR = 0.73, 95% CI = 0.62-0.85). The hazard ratios for advanced diabetes complications with regular use of antipsychotics with a high, intermediate, and low metabolic risk were 0.69 (95% CI = 0.53-0.91), 0.82 (95% CI = 0.68-0.99), and 0.85 (95% CI = 0.70-1.02), respectively. CONCLUSIONS: Regular antipsychotic treatment in the past 6 months was associated with reduced risks of any diabetes complications, compared to no antipsychotic treatment.