Creation of a Metabolic Monitoring Program for Second-Generation (Atypical) Antipsychotics

Abstract

Second-generation or ''atypical'' antipsychotics can cause metabolic derangements that lead to diabetes and cardiovascular disease. To potentially minimize these adverse effects, the University of Medicine and Dentistry of New Jersey - University Correctional HealthCare (UCHC) and the New Jersey Department of Corrections (NJ DOC) created a metabolic monitoring program that was incorporated into the electronic medical record. This program is used statewide by UCHC psychiatrists working within the NJ DOC.

Metabolic Monitoring Training Program Implementation in the Community Setting Was Associated with Improved Monitoring in Second-Generation Antipsychotic-Treated Children

“…Specifically, this study 12 found that lipid-monitoring rates increased to 83%, glucose monitoring to 65%, and WC to 43%; however, this study was conducted in a unique setting in that subjects were inmates of a correctional centre. 12 In our paper, we also observed that SGA prescription rates decreased by 58% in the time period following implementation of the MMTP in the community setting. We did not find any other studies that reported changes in overall SGA prescriptions to children after implementation of a metabolic monitoring protocol; however, one study 11 did report switching of SGA medication from those with more FDA warnings (olanzapine and clozapine) to one with fewer FDA warnings (aripiprazole) in the total population of SGA users after a warning was issued about metabolic side effects.…”

Evaluation of a computer-based intervention to enhance metabolic monitoring in psychiatry inpatients treated with second-generation antipsychotics

“…Use of SGAs has been associated with metabolic complications, including obesity, diabetes and dyslipidaemia 2 . The prevalence of metabolic syndrome in patients on SGA therapy can reach 30% or more, increasing the risk for developing coronary artery disease or stroke by 3‐fold 3–5 . Individuals with serious mental illnesses are already at an increased risk of mortality due in part to genetic risk factors, higher rates of smoking and inactivity, and lower socioeconomic status 2,6,7 .…”

“…Whereas a number of studies have confirmed the importance of monitoring metabolic parameters in patients on SGAs, 1–4 little research exists on the development and implementation of an effective monitoring program within an inpatient setting. Several outpatient monitoring programs have been described.…”

“…Several outpatient monitoring programs have been described. One focused on the collection of point of care measurements at a University‐affiliated psychiatry clinic 12 ; the other assessed the implementation and use of a metabolic monitoring program incorporated into the electronic medical records of prisoners 4 . Whereas both studies documented successful interventions, the authors of each indicated the need for further improvements in SGA‐related metabolic monitoring within high‐risk patient populations.…”

Metabolic Syndrome Prevalence and Reduction in Inmates Prescribed Antipsychotic Medications

“…In the last quarter of 2006, UCHC created and implemented a metabolic monitoring program for SGAs, using the monitoring criteria recommended by the American Diabetes Association et al (2004). This protocol, the creation of which was previously reported here (Reeves, Kaldany, Lieberman, & Vyas, 2009), specified indices to be monitored (personal and family history of obesity, diabetes, dyslipidemia, hypertension or cardiovascular disease; weight, height and body mass index (BMI); waist circumference; blood pressure; fasting blood glucose and fasting lipid profile), and the frequencies with which these indices should be monitored.…”