Cumulative ADHD medication use and risk of type 2 diabetes in adults: a Swedish Register study

Abstract

Background Little is known about the impact of cumulative attention-deficit/hyperactivity disorder (ADHD) medication use on the risk of type 2 diabetes (T2D).Objective The objective is to examine the association between cumulative use of ADHD medication and risk of incident T2D.Methods A nested case–control study was conducted in a national cohort of individuals aged 18–70 years with incident ADHD (n=138 778) between 2007 and 2020 through Swedish registers. Individuals with incident T2D after ADHD were selected as cases (n=2355) and matched with up to five controls (n=11 681) on age at baseline, sex and birth year. Conditional logistic regression models examined the association between cumulative duration of ADHD medication use and T2D.Findings Compared with no use, a decreased risk of T2D was observed for those on cumulative use of ADHD medications up to 3 years (ORs: 0<duration≤1 year, 0.79 (95% CI, 0.69 to 0.91); 1<duration≤3 years, 0.80 (95% CI, 0.69 to 0.92); duration>3 years, 0.97 (95% CI, 0.84 to 1.12)). When investigating medication types separately, methylphenidate showed results similar to main analyses, lisdexamfetamine showed no association with T2D, whereas long-term (>3 years) use of atomoxetine was associated with an increased risk of T2D (OR: 1.44 (95% CI, 1.01 to 2.04)).Conclusion Cumulative use of ADHD medication does not increase the risk for T2D, with the exception of long-term use of atomoxetine.Clinical implications Findings suggest that clinicians should be aware of the potential risk of T2D associated with the cumulative use of atomoxetine among patients with ADHD; however, further replication is strongly needed.