Metabolic screening in children receiving antipsychotic drug treatment.
OBJECTIVE
To estimate metabolic screening rates, predictors of screening, and incidence of metabolic disturbances in children initiating second-generation antipsychotic (SGA) drug treatment.


METHODS
A retrospective, new-user cohort study (between July 1, 2004, and June 30, 2006) using Medicaid claims data.


METHODS
California, Missouri, and Oregon.


METHODS
A total of 5370 children (aged 6-17 years) without diabetes mellitus taking SGA drugs and 15,000 children without diabetes taking albuterol (control individuals) [corrected] but no SGA drugs.


METHODS
Findings 1 year after recommendations from the American Diabetes Association and American Psychiatric Association called for metabolic screening of patients receiving SGA drugs.


METHODS
Serum glucose and lipid testing, 6-month incidence of diabetes, and dyslipidemia disturbances.


RESULTS
Glucose screening was performed in 1699 (31.6% [95% confidence interval (CI), 30.4%-32.9%]) SGA-treated children vs 1891 (12.6% [12.1%-13.2%]) control individuals. Lipid testing was performed in 720 (13.4% [95% CI, 12.5%-14.4%]) SGA-treated children vs 458 (3.1% [2.8%-3.3%]) controls. In multivariate logistic regression analysis, children with serious and/or multiple psychiatric diagnoses and those who used health care services more intensively were more likely to receive metabolic screening. The case incidence of glucose and lipid disorders was higher in SGA-treated vs albuterol-treated children (8.9 per 1000 children [95% CI, 6.6%-11.8%] vs 4.9 per 1000 children [3.9%-6.2%]; and 9.7 per 1000 children [95% CI, 7.2%-12.7%] vs 4.6 per 1000 children [95% CI, 3.6%-5.8%], respectively).


CONCLUSIONS
Most children starting treatment with SGA medications in this public sector sample did not receive recommended glucose and lipid screening.
Morrato
Elaine H
EH
Department of Health Systems, Management,and Policy, Colorado School of Public Health, University of Colorado at Denver, Aurora, Colorado 80045, USA. Elaine.Morrato@ucdenver.edu
Nicol
Ginger E
GE
Maahs
David
D
Druss
Benjamin G
BG
Hartung
Daniel M
DM
Valuck
Robert J
RJ
Campagna
Elizabeth
E
Newcomer
John W
JW
D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002648:Child; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D016903:Drug Monitoring / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D006949:Hyperlipidemias / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D016555:Matched-Pair Analysis; D008484:Medicaid / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D014150:Antipsychotic Agents