title: Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices.
abstract: BACKGROUND
  Despite increased cardiometabolic risk in individuals with mental illness taking antipsychotic medication, metabolic screening practices are often incomplete or inconsistent.
  
  
  METHODS
  We undertook a systematic search and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) meta-analysis of studies examining routine metabolic screening practices in those taking antipsychotics both for patients in psychiatric care before and following implementation of monitoring guidelines.
  
  
  RESULTS
  We identified 48 studies (n=290 534) conducted between 2000 and 2011 in five countries; 25 studies examined predominantly schizophrenia-spectrum disorder populations; 39 studies (n=218 940) examined routine monitoring prior to explicit guidelines; and nine studies (n=71 594) reported post-guideline monitoring. Across 39 studies, routine baseline screening was generally low and above 50% only for blood pressure [69.8%, 95% confidence interval (CI) 50.9-85.8] and triglycerides (59.9%, 95% CI 36.6-81.1). Cholesterol was measured in 41.5% (95% CI 18.0-67.3), glucose in 44.3% (95% CI 36.3-52.4) and weight in 47.9% (95% CI 32.4-63.7). Lipids and glycosylated haemoglobin (HbA1c) were monitored in less than 25%. Rates were similar for schizophrenia patients, in US and UK studies, for in-patients and out-patients. Monitoring was non-significantly higher in case-record versus database studies and in fasting samples. Following local/national guideline implementation, monitoring improved for weight (75.9%, CI 37.3-98.7), blood pressure (75.2%, 95% CI 45.6-95.5), glucose (56.1%, 95% CI 43.4-68.3) and lipids (28.9%, 95% CI 20.3-38.4). Direct head-to-head pre-post-guideline comparison showed a modest but significant (15.4%) increase in glucose testing (p=0.0045).
  
  
  CONCLUSIONS
  In routine clinical practice, metabolic monitoring is concerningly low in people prescribed antipsychotic medication. Although guidelines can increase monitoring, most patients still do not receive adequate testing.
authors.affiliation: Psycho-oncology, Leicester General Hospital, Leicestershire Partnership Trust, Leicester, UK. Alex.Mitchell@leicspart.nhs.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: Mitchell
authors.forename: V
authors.initials: V
authors.lastname: Delaffon
authors.forename: D
authors.initials: D
authors.lastname: Vancampfort
authors.forename: C U
authors.initials: CU
authors.lastname: Correll
authors.forename: M
authors.initials: M
authors.lastname: De Hert
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control; D050171:Dyslipidemias / Q000453:epidemiology / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008403:Mass Screening / Q000592:standards; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D006442:Glycated Hemoglobin