#VisualAbstract: SSRI use in pediatric patients associated with increased risk of type 2 diabetes

1. Selective serotonin reuptake inhibitor use among children and adolescents with public health insurance was found to be associated with a mildly increased risk for the developed of type 2 diabetes mellitus.

2. The magnitude of this risk, overall, was substantially lower than that of other risk factors for the developed of type 2 diabetes mellitus.

Evidence Level Rating: 2 (Good)

Selective serotonin reuptake inhibitor (SSRI) use among children aged 10 to 14 and adolescents aged 15 to 19 is widespread, with estimates at 3.5% and 6.2%, respectively. An association between SSRI use and type 2 diabetes mellitus (T2DM) has been reported in several studies conducted among adults; there is, however, a paucity of data as it relates to children and adolescents. This retrospective cohort study involved 1,582,914 children and adolescents (mean [SD] age = 15.1 [2.3] years, 58.3% female) between the age of 10 and 19 with an indication for an SSRI, identified from two national databases: the Medicaid Analytic eXtract database, consisting of patients enrolled in Medicaid and Children’s Health Insurance Programs; and the IBM Market-Scan database, consisting of patients enrolled in private health insurance plans. Patients were followed until the first diagnosis of T2DM. Among patients with public health insurance, it was found that the initiation of SSRIs was associated with a mildly increased risk of developing T2DM after adjustment (aHR 1.13, 95% CI 1.04 to 1.22). If treatment was continuous, the magnitude of association increased mildly (aHR 1.33, 95% CI 1.21 to 1.47), corresponding to a number needed to harm of 1,515 if treated continuously for at least two years and 352 if treated continuously for at least five years. Among patients with private health insurance, there was no significant association between SSRI use and T2DM, even when used continuously. Within-class risk did not differ significantly by individual SSRI medication. Furthermore, bupropion use was not associated with an increased risk of T2DM. Overall, these data suggest that SSRI use among children and adolescents with public health insurance is associated with a mildly increased risk for the development of T2DM. This magnitude of this risk is low, much lower than other risk factors for T2DM, but should be kept in mind when weighing the pros and cons of initiating SSRIs among children and adolescents.

Click to read the study in JAMA Psychiatry

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