Which Anticonvulsant Mood Stabilizer Upped Diabetes Risk?
Among adults who initiated an anticonvulsant mood stabilizer, treatment with valproate was tied with a 1.17% higher adjusted risk difference for developing T2D over 5 years compared with lamotrigine (Lamictal), in an intention-to-treat analysis (95% CI 0.66-1.76). This difference translated to a number needed to harm of 87 patients starting valproate (rather than lamotrigine) for one T2D case within 5 years.

In a per-protocol analysis of patients who adhered to treatment, the point estimate of T2D risk for valproate versus lamotrigine was slightly higher (1.99%, 95% CI -0.64 to 5.31). As for two other anticonvulsant mood stabilizers -- carbamazepine (Tegretol) and oxcarbazepine (Trileptal, Oxtellar XR) -- these agents didn't have the significantly higher 5-year T2D risk difference compared with lamotrigine:
Carbamazepine: 0.49% (95% CI -0.57 to 1.51)
Oxcarbazepine: 0.27% (95% CI -0.47 to 0.96)

This included 274,206 ages 20 to 65 (adults) and 74,005 ages 10 to 19 years (children). Some exclusion criteria included having a diagnosis of type 1, type 2, secondary or gestational diabetes and anticonvulsant medication use the year prior.

Among adult patients, there were 26,641 carbamazepine initiators, 132,739 lamotrigine initiators, 24,226 oxcarbazepine initiators, and 90,600 valproate initiators. As for kids, there were 2,532 carbamazepine initiators, 36,394 lamotrigine initiators, 12,434 oxcarbazepine initiators, and 22,645 valproate initiators. The most common medical diagnoses among this cohort included bipolar disorder, depression, anxiety, migraines, and neuropathic pain.

Source: https://www.medpagetoday.com/endocrinology/diabetes/98069