Evidence map›Paper›PMID 37753625›Full record

ArticlePsychological medicine2023

Antipsychotics and the risk of diabetes and death among adults with serious mental illnesses.

Jason Poulos, Sharon-Lise T Normand, Katya Zelevinsky, John W Newcomer, Denis Agniel, Haley K Abing, Marcela Horvitz-Lennon

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Psychological medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.3field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Multimorbidity and animal models.Animal models and experimental medicine · 2025
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 1 country.

Jason PoulosDepartment of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Sharon-Lise T NormandDepartment of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Katya ZelevinskyDepartment of Health Care Policy, Harvard Medical School, Boston, MA, USA.
John W NewcomerThriving Mind South Florida, Miami, FL, USA.
Denis AgnielRAND Corporation, Santa Monica, CA, USA.
Haley K AbingDepartment of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Marcela Horvitz-LennonRAND Corporation, Boston, MA, USA.ORCID 0000-0001-8120-9313
Harvard University · USCambridge Health Alliance · USRAND Corporation · USWashington University in St. Louis · US

Funding

Improving Minority Health by Monitoring Medicaid Quality, Disparities and ValueR01MD012428 · NIMHD · RAND CORPORATION · PI HORVITZ-LENNON, MARCELA V, NORMAND, SHARON-LISE TERESA · 2017 to 2020
$3.2M
Improving Value of Publicly Funded Mental Health CareR01MH106682 · NIMH · RAND CORPORATION · PI HORVITZ-LENNON, MARCELA V, NORMAND, SHARON-LISE TERESA · 2016 to 2019
$2.6M
NIMHD NIH HHS R01 MD012428NIMH NIH HHS R01 MH106682
6 · The paper itself

Abstract

backgroundIndividuals with schizophrenia exposed to second-generation antipsychotics (SGA) have an increased risk for diabetes, with aripiprazole purportedly a safer drug. Less is known about the drugs' mortality risk or whether serious mental illness (SMI) diagnosis or race/ethnicity modify these effects.

methodsAuthors created a retrospective cohort of non-elderly adults with SMI initiating monotherapy with an SGA (olanzapine, quetiapine, risperidone, and ziprasidone, aripiprazole) or haloperidol during 2008-2013. Three-year diabetes incidence or all-cause death risk differences were estimated between each drug and aripiprazole, the comparator, as well as effects within SMI diagnosis and race/ethnicity. Sensitivity analyses evaluated potential confounding by indication.

results38 762 adults, 65% White and 55% with schizophrenia, initiated monotherapy, with haloperidol least (6%) and quetiapine most (26·5%) frequent. Three-year mortality was 5% and diabetes incidence 9.3%. Compared with aripiprazole, haloperidol and olanzapine reduced diabetes risk by 1.9 (95% CI 1.2-2.6) percentage points, or a 18.6 percentage point reduction relative to aripiprazole users' unadjusted risk (10.2%), with risperidone having a smaller advantage. Relative to aripiprazole users' unadjusted risk (3.4%), all antipsychotics increased mortality risk by 1.1-2.2 percentage points, representing 32.4-64.7 percentage point increases. Findings within diagnosis and race/ethnicity were generally consistent with overall findings. Only quetiapine's higher mortality risk held in sensitivity analyses.

conclusionsHaloperidol's, olanzapine's, and risperidone's lower diabetes risks relative to aripiprazole were not robust in sensitivity analyses but quetiapine's higher mortality risk proved robust. Findings expand the evidence on antipsychotics' risks, suggesting a need for caution in the use of quetiapine among individuals with SMI.

Indexed as

Antipsychotic AgentsDiabetes MellitusSchizophreniaAdultAripiprazoleBenzodiazepinesHaloperidolHumansMiddle AgedOlanzapineQuetiapine FumarateRetrospective StudiesRisperidoneAntipsychotic AgentsAripiprazoleBenzodiazepinesHaloperidolOlanzapineQuetiapine FumarateRisperidoneantipsychoticmortalityrobust causal estimationSerious mental illnesstype 2 diabetes

Identifiers

PMID37753625
PMCPMC10758338
OpenAlexW4387077020

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.