title: Adherence to guidelines for glucose assessment in starting second-generation antipsychotics.
abstract: OBJECTIVE
  In 2003, the US Food and Drug Administration issued warnings about hyperglycemia and diabetes with second-generation antipsychotics (SGAs); guidelines have recommended metabolic screening since 2004. However, little is known of contemporary practices of glucose screening among youth initiating SGAs. Our objective was to evaluate baseline glucose assessment among youth in the Mini-Sentinel Distributed Database starting an SGA.
  
  
  METHODS
  The cohort included youth ages 2 through 18 newly initiating SGAs January 1, 2006, through December 31, 2011, across 10 sites. Baseline glucose was defined as fasting/random glucose or hemoglobin A1c (GLU) measurement occurring relative to first SGA dispensing. Differences in GLU assessment were evaluated with χ(2) tests and logistic regression.
  
  
  RESULTS
  The cohort included 16,304 youth; 60% boys; mean age 12.8 years. Risperidone was most commonly started (43%). Eleven percent (n = 1858) had GLU assessed between 90 days before and 3 days after first dispensing. Assessment varied across SGAs (olanzapine highest), sites (integrated health care systems higher), ages (16-18 highest), years (2007 highest), and gender (female higher; all P < .001). GLU assessment among those starting olanzapine was more likely than among those starting quetiapine (odds ratio [OR]: 1.72 [95% confidence interval (CI): 1.37-2.18]), aripiprazole (OR: 1.49 [95% CI: 1.18-1.87]), or risperidone (OR: 1.61 [95% CI: 1.28-2.03]).
  
  
  CONCLUSIONS
  Few children and adolescents starting SGA have baseline glucose assessed. This is concerning because those at high diabetes risk may not be identified. Further, lack of screening impedes determining the contribution of SGAs to hyperglycemia development.
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado; marsha.a.raebel@kp.org.
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Raebel
authors.affiliation: Group Health Research Institute, Seattle, Washington;
authors.forename: Robert
authors.initials: R
authors.lastname: Penfold
authors.affiliation: Office of Pediatric Therapeutics, Office of the Commissioner, and.
authors.forename: Ann W
authors.initials: AW
authors.lastname: McMahon
authors.affiliation: Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland;
authors.forename: Marsha
authors.initials: M
authors.lastname: Reichman
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado;
authors.forename: Susan
authors.initials: S
authors.lastname: Shetterly
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado;
authors.forename: Glenn
authors.initials: G
authors.lastname: Goodrich
authors.affiliation: Meyers Primary Care Institute, a joint endeavor of Fallon Community Health Plan, Reliant Medical Group, and University of Massachusetts Medical School, Worcester, Massachusetts;
authors.forename: Susan
authors.initials: S
authors.lastname: Andrade
authors.affiliation: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, New York; and.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Rutgers University, Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, and Ernest Mario School of Pharmacy, Piscataway, New Jersey.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gerhard
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000139:chemically induced; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents; D001786:Blood Glucose
keywords: adolescent; antipsychotic agents; aripiprazole; child; glucose; glycosylated hemoglobin; guideline adherence; hyperglycemia; monitoring; olanzapine; quetiapine; retrospective studies; risperidone; second-generation antipsychotic; youth