Metabolic Screening After the American Diabetes Association's Consensus Statement on Antipsychotic Drugs and Diabetes
- Elaine H. Morrato, DRPH, MPH1,
- John W. Newcomer, MD2,
- Siddhesh Kamat, MS3,
- Onur Baser, PHD4,
- James Harnett, PHARMD, MS5 and
- Brian Cuffel, PHD5
- 1Departments of Pediatrics, Health Services Management and Policy, and Clinical Pharmacy, University of Colorado Denver, Aurora, Colorado;
- 2Departments of Psychiatry, Psychology, and Medicine and the Center for Clinical Studies, Washington University School of Medicine, St. Louis, Missouri;
- 3HealthCore, Wilmington, Delaware;
- 4STATInMED, University of Michigan, Ann Arbor, Michigan;
- 5Pfizer, New York, New York.
- Corresponding author: Elaine Morrato, elaine.morrato{at}ucdenver.edu.
Abstract
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.
RESEARCH DESIGN AND 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.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received September 27, 2008.
- Accepted February 11, 2009.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2009 by the American Diabetes Association.
