The Need for a Lifecourse Approach to Drug Safety: Anticonvulsant Medications and Risk of Type 2 Diabetes

​Jenny Sun, PhD

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The impact of medication use during childhood and adolescence is understudied. Children have traditionally been excluded from randomized trials largely due to ethical concerns and the challenges of obtaining consent of minors, resulting in a lack of evidence to inform treatment decision making. Unfortunately, this lack of evidence-based prescribing has immediate and potentially lifelong consequences. An estimated 200,000 children in the United States visit the emergency department each year due to an adverse drug reaction. Beyond these urgent consequences, there is emerging research that points to long term impacts, specifically raising the question: could this lack of evidence on drug safety also be related to the increasing burden of youth-onest type 2 diabetes?

Recent evidence shows medication use as a potential risk factor for type 2 diabetes. Youth-onset of type 2 diabetes is a potential side effect of several chronic treatments, including antipsychotics and oral corticosteroids. Developing type 2 diabetes during childhood is particularly concerning because children generally have a more aggressive condition than adults, and would have to manage this for most of their lives. Therefore, more pediatric drug safety data are needed to not only inform treatment decision making, but also to help prevent the risk of developing chronic diseases that may have a lifelong impact on one’s well-being. For patients who receive treatment for a chronic disease, there may be several similarly effective medications to choose from. Could treatment choice across the lifecourse have an impact on ones risk of developing type 2 diabetes?

This was recently explored for anticonvulsant mood stabilizer treatment, which is widely used in both children and adults to treat epilepsy, bipolar disorder, and neuropathic pain (conditions that may require long-term treatment). Patients may initiate anticonvulsant mood stablizers throughout the lifecourse (including during childhood), so age-specific drug safety data are needed. This study included both children and adults, as it was a noninterventional epidemiologic study that did not face the challenges that randomized trials face when enrolling children.

Researchers found that of the four anticonvulsant mood stabilizers available in the United States, lamotrigine was associated with the lowest risk of type 2 diabetes in both children and adults. Based on this evidence, patients who seek anticonvulsant mood stabilizer treatment but may be concerned about future metabolic side effects could consider lamotrigine treatment (if effectiveness of treatment is similar for the indicated condition and the reduced metabolic risk outweighs the other known risks associated with lamotrigine treatment). At a population level, this means that the choice of which anticonvulsant mood stabilizer to initiate could have meaningful reductions in the incidence of type 2 diabetes in children and adults.

This reduction in risk could be especially important for children given the aggressive nature and early onset of the disease. Taking a lifecourse approach to evaluate the risk of developing type 2 diabetes associated with antivonsulant mood stabilizer treatment provides the age-specific drug safety data needed and highlights the potential for epidemiologic studies to fill the gap in knowledge on medication safety in children.
The content of this post reflect only the author's views.

About the Author

Jenny Sun is a former Research Fellow in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute. Her work focuses primarily on medication safety and the use of secondary databases to conduct pharmacoepidemiologic studies. Outside of work, Jenny enjoys staying active, spending time with family and friends, and exploring new places to eat.