Nyligen publicerades i JAMA Network Open.
Studien visar att användningen av så kallade psykotropa läkemdelel såsom antidepressiva läkemedel eller medicin mot adhd hos barn och unga med typ 1-diabetes har ökat fem gånger mellan 2006 och 2019.
Länk till publikation: ”Psychotropic Medication Use in Children and Adolescents With Type 1 Diabetes”
Intervju med forskaren Shengxin Liu:
What does your publication show?
Psychotropic medication dispensation increased nearly five times in children and adolescents with type 1 diabetes from 2006 to 2019. This population-based cohort study of Swedish children and adolescents found that, from 2006 to 2019, the dispensation of psychotropic medications, particularly hypnotics, attention-deficit/hyperactivity disorder medication, anxiolytics, and antidepressants, increased from 0.85% to 3.84% among children with type 1 diabetes and from 2.72% to 13.54% among adolescents with type 1 diabetes. For these children and adolescents, psychiatric care was the primary prescription source, and up to 50.1% of these psychotropic medication treatments lasted for more than 12 months.
Why are the results important?
This is, to our knowledge, the first and largest to systematically examine the pattern and trends of psychotropic medication use for children and adolescents with type 1 diabetes. Our observed increased trends and the proportion of long-term treatment highlight the need for clinical attentiveness and recommendations for psychotropic medication therapy in this population. Our findings could inspire future research to specifically evaluate the benefits and risks of the widely-used medications, i.e. ADHD medication and hypnotics, in this population.
How did you perform the study?
This is a population-based cohort study of 3,723,745 children and adolescents, among whom 13,200 had type 1 diabetes, residing in Sweden from 2006 to 2019. We examined trends and patterns of their psychotropic medication dispensation (including antipsychotics, antidepressants, anxiolytics, hypnotics, mood stabilizers, and medications for attention-deficit/hyperactivity disorder). We also estimated their cumulative incidence and hazard ratio of initiating psychotropic medication after diabetes onset in comparison to their healthy peers.
What is the next step in your research?
One upcoming study will examine the effectiveness and risks of attention-deficit/hyperactivity disorder (ADHD) medication, one of the most commonly used psychotropic medications, in children and adolescents with type 1 diabetes in terms of their diabetes management and risk of adverse outcomes.
Press release Karolinska
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October 3, 2023
Psychotropic Medication Use in Children and Adolescents With Type 1 Diabetes
Shengxin Liu, MSc1; Tyra Lagerberg, PhD1,2; Jonas F. Ludvigsson, PhD1,3,4; et alMark J. Taylor, PhD1; Zheng Chang, PhD1; Brian M. D’Onofrio, PhD1,5; Henrik Larsson, PhD1,6; Paul Lichtenstein, PhD1; Soffia Gudbjörnsdottir, PhD7,8; Ralf Kuja-Halkola, PhD1; Agnieszka Butwicka, PhD1,9,10,11
Key Points
Question What are the trends and patterns of psychotropic medications used for children and adolescents with type 1 diabetes (T1D)?
Findings This population-based cohort study of more than 3.7 million Swedish children and adolescents found that, from 2006 to 2019, the dispensation of psychotropic medications, particularly hypnotics, attention-deficit/hyperactivity disorder medication, anxiolytics, and antidepressants, increased from 0.85% to 3.84% among children and from 2.72% to 13.54% among adolescents with T1D. For those with T1D, psychiatric care was the primary prescription source; up to 50.1% of treatments lasted more than 12 months.
Meaning These findings call for further research to evaluate the benefits and risks of psychotropic medications for children and adolescents with T1D and highlight the need for clinical attentiveness and recommendations.
Abstract
Importance Children and adolescents with type 1 diabetes (T1D) face elevated risks of psychiatric disorders. Despite their nonnegligible adverse effects, psychotropic medications are a common cost-effective approach to alleviating psychiatric symptoms, but evidence regarding their dispensation to children and adolescents with T1D remains lacking.
Objective To examine the trends and patterns of psychotropic medication dispensation among children and adolescents with T1D in Sweden between 2006 and 2019.
Design, Setting, and Participants This cohort study used data from multiple Swedish registers. The main study cohort included children and adolescents residing in Sweden from 2006 to 2019 and was followed up until the earliest of December 31, 2019, 18th birthday, emigration, or death. Data analyses were conducted from November 1, 2022, to April 30, 2023.
Exposures Type 1 diabetes.
Main Outcomes and Measures The primary outcomes were trends and patterns of psychotropic medication dispensation (including antipsychotics, antidepressants, anxiolytics, hypnotics, mood stabilizers, and medications for attention-deficit/hyperactivity disorder [ADHD]), psychotropic medication initiation, and history of neurodevelopmental and psychiatric diagnosis. Cumulative incidence curves and Cox proportional hazard models were used to estimate the aggregated incidence and hazard ratios of medication initiation after diabetes onset.
Results Of 3 723 745 children and adolescents (1 896 199 boys [50.9%]), 13 200 (0.4%; 7242 boys [54.9%]) had T1D (median [IQR] age at diagnosis, 11.1 [7.6-14.7] years). Between 2006 and 2019, psychotropic medication dispensation increased from 0.85% (95% CI, 0.65%-1.10%) to 3.84% (3.11%-4.69%) among children and from 2.72% (95% CI, 2.15%-3.39%) to 13.54% (95% CI, 12.88%-14.23%) among adolescents with T1D, consistently higher than their peers without T1D. The most commonly dispensed medications included hypnotics, ADHD medications, anxiolytics, and selective serotonin reuptake inhibitors, and all exhibited increasing trends. For those with T1D, psychiatric care was the primary prescription source, and up to 50.1% of treatments lasted more than 12 months. In addition, children and adolescents with T1D showed higher cumulative incidence and hazard ratios of medication initiation after diabetes onset than their same-age and same-sex counterparts.
Conclusions and Relevance This cohort study found an increasing trend in psychotropic medication dispensation among children and adolescents with T1D from 2006 to 2019, persistently higher than those without T1D. These findings call for further in-depth investigations into the benefits and risks of psychotropic medications within this population and highlight the importance of integrating pediatric diabetes care and mental health care for early detection of psychological needs and careful monitoring of medication use.