Antidepressant and antipsychotic drug prescribing and complications of diabetes: a systematic review of observational studies

AimsPsychotropic medication may be associated with adverse effects, particularly in people with diabetes. We conducted a systematic review of observational studies investigating the association between antidepressant or antipsychotic drug prescribing and diabetes outcomes. MethodsWe systematically searched PubMed, EMBASE, and PsycINFO to 15th August 2022 to identify eligible studies. We used the Newcastle-Ottawa scale to assess study quality and performed a narrative synthesis. ResultsWe included 18 studies, 14 reporting on antidepressants and four on antipsychotics. There were 11 cohort studies, one self-controlled before and after study, two case-control studies, and four cross-sectional studies, of variable quality and highly heterogeneous in terms of study population, exposure definition and outcome analysed. Antidepressant prescribing may be associated with increased risk of macrovascular outcomes, whilst evidence on antidepressant and antipsychotic prescribing and glycaemic control was mixed. Few studies reported on microvascular complications and cardiometabolic factors other than glycaemic control and just one study reported on antipsychotics and diabetes complications. ConclusionsThere has been little study of antidepressant and antipsychotic drug prescribing in relation to diabetes outcomes. Further, more methodologically robust, research is needed to inform and enhance antidepressant and antipsychotic drug prescribing and monitoring practices in people with diabetes.