Findings of a U.S. National Cardiometabolic Screening Program Among 10,084 Psychiatric Outpatients

Correll, Christoph U.; Druss, Benjamin G.; Lombardo, Ilise; O’Gorman, Cedric; Harnett, James; Sanders, Kafi N.; Alvir, José; Cuffel, Brian J.

doi:10.1176/ps.2010.61.9.892

Cited by 86 publications

(59 citation statements)

References 44 publications

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“…Subjects were divided into patients (SGAtreated for at least 7 days) and control subjects (SGA-naive on admission and never previously exposed to an SGA). Based on previous literature, 23,28,[41][42][43][44][45][46][47][48] a limited number of pre-specified demographic and clinical characteristics of the groups (see rationale provided for the logistic regression below) were selected, a priori, and compared, using 2-tailed, independent samples t tests, and the remaining data are presented descriptively to limit alpha-type error. Where the data were not normally distributed, Mann-Whitney U tests were performed.…”

Section: Discussionmentioning

confidence: 99%

“…[42][43][44][45][46] Therefore, independent variables included in the analysis were age, sex, SGA treatment, concomitant medications promoting weight gain (mood stabilizers, antidepressants, and FGAs), or medications promoting weight loss (psychostimulants and strattera), high-risk ethnicity (Aboriginal, Asian, South Asian, African, Caribbean, and Hispanic), and psychotic and bipolar disorders. The dependent variable was MetS diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Waist Circumference is a Sensitive Screening Tool for Assessment of Metabolic Syndrome Risk in Children Treated with Second-Generation Antipsychotics

et al. 2012

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Objective:To compare the prevalence of metabolic syndrome (MetS) and its components in second-generation antipsychotic (SGA)-treated and SGA-naive children; and to explore the utility of clinical markers, such as waist circumference (WC) and body mass index (BMI), as screening tools for MetS.Methods: Subjects were prospectively recruited from the Psychiatry Emergency Unit at British Columbia Children's Hospital. As part of a quality-assurance project, a metabolic monitoring protocol was implemented, including collection of anthropomorphic and laboratory data.Results: From January 2008 to February 2010, there were 117 SGA-treated and 217 SGA-naive children recruited. The overall prevalence of MetS was 19.0% (16/84; median treatment duration = 14 months) in SGA-treated and 0.8% (1/127) in SGA-naive children (OR 29.7; 95% CI 3.85 to 228.40, P < 0.001), with an increased prevalence of all components except high-density lipoprotein cholesterol (HDL-C), respectively: elevated WC (40.7% and 10.1%; P < 0.001); hypertriglyceridemia (33.7% and 18.8%; P = 0.01); impaired fasting glucose (12.5% and 0.7%; P = 0.005); and elevated blood pressure (41.2% and 16.5%; P < 0.001). SGA treatment was the strongest predictor of MetS (OR 19.2; 95% CI 2.30 to 160.44, P = 0.006) followed by male sex (OR 5.7; 95% CI 1.08 to 30.62, P = 0.04). Presence of abdominal obesity was more sensitive (92.9%) than BMI (68.8%), while fasting glucose of 5.6 mmol/L or more and HDL-C of 1.03mmol/L or less were most specific (94.1%) in correctly identifying MetS.Conclusions: SGA treatment confers a significantly increased risk for MetS over the long term. WC measurement is a simple and sensitive screening tool for determining MetS risk in SGA-treated children. These data highlight the dangers of SGA treatment and the importance of standardized metabolic monitoring using sex-and age-adjusted tables in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Waist Circumference is a Sensitive Screening Tool for Assessment of Metabolic Syndrome Risk in Children Treated with Second-Generation Antipsychotics

et al. 2012

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“…36 In a community sample, among people with schizophrenia who reported they had diabetes, 41 % reported not receiving antihyperglycemic treatment. 65 In another study of diabetes patients, those with SMI were 29 % less likely to be prescribed cholesterol-lowering statin medications, and 20 % less likely to be prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor blocking agents than diabetes patients without SMI. 66 In a large VA study (N = 313,586) of people with diabetes, failure to meet diabetes performance measures was more common among people with mental illnesses, adjusting for various confounders, with AOR1.…”

Section: Management Of Type 2 Diabetes and Other Cardiovascular Diseamentioning

confidence: 99%

Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

et al. 2016

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Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications. In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system. Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.KEY WORDS: mental illness; diabetes; integration of care.

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“…Over 50% of adults with serious mental illness are obese. 1 Persons with schizophrenia consume more calories and saturated fats, on average, than the general population, while fewer than 20% engage in regular physical activity. 2 These poor health behaviors lead to a markedly increased risk of premature death among individuals with serious mental illness, largely due to cardiovascular disease and other chronic medical conditions associated with obesity.…”

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confidence: 99%

Making Evidence-Based Lifestyle Modification Programs Available in Community Mental Health Centers: Why So Slow?

Chwastiak¹

2015

J. Clin. Psychiatry

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Findings of a U.S. National Cardiometabolic Screening Program Among 10,084 Psychiatric Outpatients

Abstract: The prevalence of metabolic syndrome and cardiometabolic risk factors, such as overweight, hypertension, dyslipidemia, and glucose abnormalities, was substantial and frequently untreated in this U.S. national mental health clinic screening program.

Cited by 86 publications

References 44 publications

Waist Circumference is a Sensitive Screening Tool for Assessment of Metabolic Syndrome Risk in Children Treated with Second-Generation Antipsychotics

Waist Circumference is a Sensitive Screening Tool for Assessment of Metabolic Syndrome Risk in Children Treated with Second-Generation Antipsychotics

Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

Making Evidence-Based Lifestyle Modification Programs Available in Community Mental Health Centers: Why So Slow?

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