A recent Dutch cohort study highlights a sharp, sustained rise in medically treated type 2 diabetes among children and adolescents following antipsychotic treatment, underscoring the need for immediate metabolic monitoring and preventive strategies.
Antipsychotic treatment in children and adolescents is linked to a sharp and sustained rise in medically treated type 2 diabetes, according to a Dutch cohort study published in JAMA Network Open. Researchers followed 89,991 young people aged 0 to 19 years for five years before and after their first antipsychotic prescription, using a self-controlled design intended to reduce bias from fixed individual characteristics.
Before treatment began, rates of diabetes remained low and fairly stable. After antipsychotics were started, however, prevalence rose quickly, reaching 6.22 cases per 10,000 users in the first year and 14.58 by year five. The investigators said the pattern was not present before treatment began, strengthening the case that the increase was associated with antipsychotic exposure rather than an underlying upward trend.
The effect was not evenly distributed. By year five, girls showed a larger excess risk than boys, and adolescents aged 13 to 19 accumulated more additional cases than children aged 7 to 12. The rise also appeared to persist even in those whose exposure was limited to the first year, suggesting that early metabolic changes may not fully reverse after stopping treatment in some patients. The authors said structured metabolic monitoring should begin when treatment starts, alongside early preventive measures such as dietetic support and encouragement of physical activity.
The findings fit a broader body of evidence that has long connected antipsychotics with diabetes and other metabolic harms. A review in Current Diabetes Reports concluded that diabetes is more common in people with severe mental illness and that some antipsychotics can drive risk through weight gain as well as direct effects on insulin sensitivity and secretion. Separate mechanistic research from the University of Toronto has also suggested that these drugs may interfere with the brain’s ability to sense glucose and regulate metabolism, adding a central nervous system pathway to the risk picture.
Monitoring remains a practical weak spot. The Dutch authors noted that routine laboratory follow-up is often inconsistent in children prescribed antipsychotics, while pharmacy professionals may be well placed to reinforce screening, counselling and side-effect management between clinic visits. The study could only measure diabetes cases treated with medication, meaning it likely missed milder or undiagnosed disease, and it did not separate risk by individual drug. Even so, the authors argued the message is clear: metabolic surveillance in young patients should start immediately, not after problems emerge.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
