Metabolic screening after the American Diabetes Association's consensus statement on antipsychotic drugs and diabetes.
OBJECTIVE
Several second-generation antipsychotic (SGA) drugs have been associated with weight gain, hyperglycemia, and dyslipidemia. We evaluated whether glucose and lipid testing increased after the American Diabetes Association (ADA) consensus statement recommending metabolic monitoring for SGA-treated patients.


METHODS
Laboratory claims for serum glucose and lipid testing were identified for an incident cohort of 18,876 adults initiating SGA drugs in a U.S. commercial health plan (2001-2006) and a control group of 56,522 adults with diabetes not receiving antipsychotics. Interrupted time-series models were used to estimate the effect of ADA recommendations on baseline and annual testing trends after adjusting for differences in age, sex, mental health diagnoses, and cardiovascular risk using propensity score matching.


RESULTS
Mean baseline testing rates for SGA-treated patients during the study period were 23% (glucose) and 8% (lipids). Among persistent users of SGA medication, annual testing rates were 38% (glucose) and 23% (lipid). Before the ADA statement, screening rates for SGA-treated patients were increasing (glucose: baseline 3.6% per year, annual 7.2% per year; lipid: baseline 1.2% per year, annual 4.8% per year; P < 0.001 for each trend). Increases were similar to background testing trends in control subjects. The ADA statement was not associated with an increase in screening rates.


CONCLUSIONS
In a commercially insured population, glucose and lipid testing for SGA-treated adults was infrequent. A gradual increase in screening rates occurred over the 6-year period, but the changes were not temporally associated with the ADA statement. More effort is needed to improve diabetes and dyslipidemia screening in these at-risk patients.
Morrato
Elaine H
EH
Departments of Pediatrics, Health Services Management and Policy, and Clinical Pharmacy, University of Colorado Denver, Aurora, Colorado, USA. elaine.morrato@ucdenver.edu
Newcomer
John W
JW
Kamat
Siddhesh
S
Baser
Onur
O
Harnett
James
J
Cuffel
Brian
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D003245:Consensus Statements as Topic; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D001523:Mental Disorders / Q000097:blood / Q000188:drug therapy; D008603:Mental Health; D008875:Middle Aged; D012307:Risk Factors; D012955:Societies, Medical; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States
D018687:Antidepressive Agents, Second-Generation; D001786:Blood Glucose; D008055:Lipids