Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices

Mitchell, Alex J.; Delaffon, Vijay; Vancampfort, Davy; Correll, Christoph U.; Hert, Marc De

doi:10.1017/s003329171100105x

Cited by 292 publications

(255 citation statements)

References 114 publications

Supporting

Mentioning

237

Contrasting

Unclassified

Order By: Relevance

“…Risperidone was the SGA most commonly started (43%; n = 6956), followed by aripiprazole (31%; n = 5035), quetiapine (20%; n = 3245), olanzapine (4%; n = 659), and other agents (2%; n = 409). The cohort age distribution included 2% (n = 364) ages 2 to 4 years, 22% (n = 3508) ages 5 to 9, 17% (n = 2738) ages 10 to 12, 26% (n = 4282) ages 13 to 15, and 33% (n = 5412) ages 16 Detailed results of baseline GLU assessment data availability for 14 days before through 3 days after, 90 days before through 3 days after, and 90 days before through 30 days after starting an SGA are shown in Tables 1 and 2. Eleven percent (n = 1858) of youth had GLU assessed between 90 before and 3 days after the first SGA dispensing date.…”

Section: Resultsmentioning

confidence: 99%

“…They documented cardiometabolic monitoring practices had not changed substantially since the FDA warnings, SGA product label revisions, and national monitoring guidelines issuance. Mitchell et al 16 recently conducted a systematic review and meta-analysis of international studies of metabolic monitoring, including studies published before and after formal monitoring guidelines were available. They too found that suboptimal metabolic monitoring among patients prescribed SGAs continued after guidelines were published.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

See 1 more Smart Citation

Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Raebel

Penfold

McMahon³

et al. 2014

Pediatrics

View full text Add to dashboard Cite

OBJECTIVES: 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 χ2 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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: (Continued On Last Page)mentioning

confidence: 99%

Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Raebel

Penfold

McMahon³

et al. 2014

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Some of the possible barriers to screening in practice include uncertainty as to whether such physical health screening was the responsibility of the psychiatric team rather than a primary care clinician [20], a lack of confidence in the interpretation of abnormal screening results [21] and limited access to basic infrastructure such as IT equipment [22]. Other possible explanations for the relatively low level of screening is that clinicians may target patients for the assessment of metabolic side effects rather than routinely screen all patients prescribed antipsychotic medication.…”

Section: Discussionmentioning

confidence: 99%

Anti-Psychotic Medication and the Pattern of Cardiovascular Risk Factors: A Population Based Study (The Ayrshire Diabetes Follow-Up Cohort (ADOC) Study)

Collier¹,

Kessavalou²,

Sit³

et al. 2017

J Addict Res Ther

View full text Add to dashboard Cite

show abstract

“…Our group reviewed 38 studies, involving 217 539 patients, that examined routine monitoring of patients taking anti psychotics before the implementation of explicit guidelines (Mitchell 2012). Across all baseline studies, routine monitoring rates were generally low but were highest for blood pressure (67%) and triglycerides (60%).…”

Section: Medical Care and Metabolic Monitoring In Psychiatric Settingsmentioning

confidence: 99%

Let's get physical: improving the medical care of people with severe mental illness

Mitchell¹,

Delaffon²,

Lord³

2012

Adv. psychiatr. treat

View full text Add to dashboard Cite

SummaryThere is clear evidence of increased medical comorbidity and related mortality in people with severe mental illness, despite numerous guidelines for managing medical conditions in this population. This article assesses inequalities in medical treatment and preventive healthcare received by psychiatric patients compared with the general population. It considers whether the medical care provided is adequate and whether published guidelines improve it. Mental health specialists, general practitioners and hospital specialists appear to deliver poorer than average medical care for this vulnerable population. Implementation of physical healthcare guidelines is incomplete and the guidelines must be matched with resources to address this deficit.

show abstract

Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices

Abstract: In routine clinical practice, metabolic monitoring is concerningly low in people prescribed antipsychotic medication. Although guidelines can increase monitoring, most patients still do not receive adequate testing.

Cited by 292 publications

References 114 publications

Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Anti-Psychotic Medication and the Pattern of Cardiovascular Risk Factors: A Population Based Study (The Ayrshire Diabetes Follow-Up Cohort (ADOC) Study)

Let's get physical: improving the medical care of people with severe mental illness

Contact Info

Product

Resources

About