The following is a summary of “Association of Long-term Antiseizure Medication Use and Incident Type 2 Diabetes Mellitus,” published in the May 2023 issue of Neurology by Tseng, et al.

Individuals with epilepsy are at increased risk of developing comorbidities such as type 2 diabetes mellitus (DM). For a study, researchers sought to investigate whether long-term antiseizure medication (ASM) use is associated with the risk of developing type 2 diabetes.

The study analyzed data from the Chang Gung Research Database, identifying patients aged ≥45 years who received ASM treatment between January 2001 and May 2019. Patients with DM-associated diseases and short-term ASM use were excluded. The patients were classified into non-enzyme interaction, enzyme-inducing, enzyme-inhibiting, and mixed ASM groups. The rate of incident diabetes associated with individual ASMs was further analyzed. Propensity score weighting was performed to balance between-group differences. Analyses were conducted with Cox proportional regression models and stabilized inverse probability of treatment weighting (IPTW). Hazard ratios (HRs) were calculated at 3, 4, 6, and 9 years after the index date and the end of follow-up.

A total of 5,103 patients were analyzed. During follow-up (39,248 person-years), 663 patients developed new-onset DM, and the prevalence was 13.0%. The incidence of DM plateaued at 6–9 years after ASM initiation. Enzyme-inhibiting ASMs were significantly associated with a higher HR starting in the third year and then throughout the study period. The HRs were 1.93 (95% CI 1.33–2.80), 1.85 (95% CI 1.24–2.75), and 2.08 (95% CI 1.43–3.03) in unadjusted, adjusted, and stabilized IPTW models, respectively, at the end of follow-up. The dosing of ASM did not increase the risk of DM, and none of the individual ASM analyses reached statistical significance.

The long-term use of enzyme-inhibiting ASMs was associated with an increased risk of incident DM, and the risk increased with the duration of treatment. The findings may guide the choice of drugs in those requiring long-term ASM therapy, particularly in high-risk individuals.

Source: n.neurology.org/content/100/20/e2071