Metabolic monitoring in veterans with schizophrenia-related disorders and treated with second-generation antipsychotics: findings from a Veterans Affairs-based population.
OBJECTIVE
To describe the proportions of veterans living with schizophrenia-related disorders monitored for dyslipidemia and hyperglycemia and to investigate whether the likelihood of metabolic dysregulation monitoring was influenced by veterans' sociodemographic characteristics, preswitch pharmacologic treatment, and monitoring before the switch from one second-generation antipsychotic (SGA) to another.


METHODS
Retrospective, observational, descriptive study.


METHODS
Veterans Affairs (VA) Healthcare System between October 1, 2001, and December 31, 2003.


METHODS
1,826 veterans with schizophrenia-related disorders.


METHODS
Veterans who were dispensed two or more prescriptions for one of five SGAs (i.e., clozapine, olanzapine, quetiapine, risperidone, and ziprasidone) on the VA Healthcare System formulary were identified. Of these veterans, a subset that was switched from one SGA to another was identified. From this subset, veterans were identified who were on the first SGA continuously for at least 90 days before the index date and the new SGA for 180 or more days after. Finally, among these veterans, ICD-9 codes were used to identify veterans with a schizophrenia or schizoaffective disorder diagnosis (ICD-9 code 295.xx or 296).


METHODS
Proportions of veterans with lipid (i.e., low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides) and blood glucose (i.e., fasting blood glucose [FBG], glycosylated hemoglobin [A1C]) laboratory results.


RESULTS
Nearly 39% of the veterans had at least one of three lipid fractions monitored 6 months or less before their SGA switch and 59% during the 12 months after. The corresponding proportions of veterans monitored were 57% and 80% for FBG and 19% and 31% for A1C. Pharmacologic agent for metabolic dysregulation, monitoring during the 6 months before the switch, and age 50 years or older were significant predictors of monitoring after the SGA switch for all three laboratory parameters.


CONCLUSIONS
These findings serve as a benchmark for lipid and blood glucose monitoring among patients who switch SGA therapy. Veterans' metabolic dysregulation was more likely to be monitored after SGA switch for those receiving pharmacologic treatment for metabolic dysregulation, monitored before the switch, and aged 50 years or older. Implementation of monitoring guidelines in daily practice is emphasized to ensure that individuals living with schizophrenia-related disorders and taking SGAs achieve optimal physical health.
Hsu
Chienning
C
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville 32610-0496, USA.
Ried
L Douglas
LD
Bengtson
Michael A
MA
Garman
Patrick M
PM
McConkey
Joel R
JR
Rahnavard
Farzad
F
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D016903:Drug Monitoring / Q000592:standards*; D050171:Dyslipidemias / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D012959:Socioeconomic Factors; D014280:Triglycerides / Q000097:blood; D014481:United States; D014493:United States Department of Veterans Affairs
D014150:Antipsychotic Agents; D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides