Metabolic monitoring for youths initiating use of second-generation antipsychotics, 2003-2011.
OBJECTIVE
In 2004, the American Diabetes Association (ADA) released treatment guidelines recommending metabolic screening for children and adolescents before and after initiation of second-generation antipsychotics. Prior studies showed that the guidelines coincided with a small increase in glucose testing of children and adults but had limited follow-up. This study sought to evaluate changes in metabolic screening of children initiating second-generation antipsychotics around the time of the 2004 guidelines and in the following eight years.


METHODS
Study patients (N=52,407) were identified in a large nationwide commercial insurance claims database for the period January 1, 2003, through December 31, 2011. The study population was a cohort of nondiabetic new users of second-generation antipsychotics who were ages 5-18. Glucose and HbA1c tests completed before and after second-generation antipsychotic initiation were identified with Current Procedural Terminology-4 codes. Metabolic screening was also examined by second-generation antipsychotic agent prescribed and psychiatric diagnosis.


RESULTS
The proportion of patients receiving a glucose test preinitiation increased from 17.9% in 2003 to 18.9% in 2004, and testing postinitiation increased from 14.7% to 16.6% in the same period. The slight increase in glucose testing was not sustained; the proportion tested dropped in the following years before rising again in 2008. Glucose screening was most common for patients taking aripiprazole. Patients with a diagnosis of hyperkinetic disorder were less likely to be tested. HbA1c testing was less frequent but had a similar usage pattern.


CONCLUSIONS
The small improvement in metabolic screening immediately after the 2004 ADA guidelines were issued was not sustained. Overall, metabolic screening rates remained suboptimal throughout the study period.
The authors are with the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston (e-mail: joc121@mail.harvard.edu).
John G
JG
Connolly
The authors are with the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston (e-mail: joc121@mail.harvard.edu).
Timothy J
TJ
Toomey
The authors are with the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston (e-mail: joc121@mail.harvard.edu).
Maria C
MC
Schneeweiss
D000293:Adolescent; D000341:Affective Disorders, Psychotic / Q000188:drug therapy; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001008:Anxiety Disorders / Q000188:drug therapy; D000068180:Aripiprazole / Q000009:adverse effects; D001569:Benzodiazepines / Q000009:adverse effects; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019955:Conduct Disorder / Q000188:drug therapy; D016208:Databases, Factual; D003866:Depressive Disorder / Q000188:drug therapy; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D006948:Hyperkinesis / Q000188:drug therapy; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000188:drug therapy*; D000077152:Olanzapine; D010879:Piperazines / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy; D000069348:Quetiapine Fumarate / Q000009:adverse effects; D012189:Retrospective Studies; D018967:Risperidone / Q000009:adverse effects; D013844:Thiazoles / Q000009:adverse effects
D014150:Antipsychotic Agents; D000068180:Aripiprazole; D001569:Benzodiazepines; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D000077152:Olanzapine; D010879:Piperazines; D000069348:Quetiapine Fumarate; D018967:Risperidone; D013844:Thiazoles; C517652:hemoglobin A1c protein, human; C092292:ziprasidone