Prevalence and Predictors of Lipid and Glucose Monitoring in Commercially Insured Patients Treated With Second-Generation Antipsychotic Agents

Haupt, Dan; Rosenblatt, Lisa; Kim, M.B.A. Edward; Baker, M.B.A. Ross A.; Whitehead, B.S. Richard; Newcomer, John W.

doi:10.1176/appi.ajp.2008.08030383

Cited by 166 publications

(153 citation statements)

References 33 publications

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“…This frequency of 11% of baseline glucose testing for children and adolescents ages 2 through 18 prescribed SGAs is similar to that reported by Haupt et al 15 This work also has limitations. The large national insurance plans participating as Mini-Sentinel data partners only have access to laboratory results data from a subset (not all) of their enrollees.…”

Section: Discussionsupporting

confidence: 86%

“…An epidemiologic study by Haupt et al 15 employing laboratory claims data from patients of all ages up to 65 years treated with SGAs between 2000 and 2006 demonstrated that metabolic monitoring was not conducted as recommended. They documented cardiometabolic monitoring practices had not changed substantially since the FDA warnings, SGA product label revisions, and national monitoring guidelines issuance.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

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

Raebel

Penfold

McMahon³

et al. 2014

Pediatrics

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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.

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Section: Discussionsupporting

confidence: 86%

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

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“…50,51 Specifically, ADA/APA guidelines recommend quarterly weight and BMI measurements; annual monitoring of blood pressure, fasting glucose, and waist circumference; and fasting lipids every 5 years or Bmore frequently if clinically indicated.^5 1 Unfortunately, over 10 years after publication of these diabetes screening guidelines, 70 % of people taking SGAs remain unscreened for diabetes or dyslipidemia. [52][53][54][55][56] Based on estimates that 20 % of the 19 million US adults with SMI have diabetes 26 and 70 % of them are not screened for diabetes 53,57 ; over 2 million Americans have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, 58 this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates into over $8 billion in annual preventable costs to the healthcare system.…”

Section: Screening For 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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“…73 Just as in other countries, 93 the availability of physical health screening guidelines has not ensured minimal screening standards are met for physical health problems such as CVD. Screening and monitoring protocols and guidelines are available in Australia 45,46,54,70,75,77,94 (see Table 2) and overseas.…”

Section: Discussionmentioning

confidence: 99%

Applying the World Health Organization Mental Health Action Plan to evaluate policy on addressing co-occurrence of physical and mental illnesses in Australia

Happell

Platania‐Phung

Webster³

et al. 2015

Aust. Health Review

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Objectives. The aim of the present study was to document Australian policies on the physical health of people with mental illness and evaluate the capacity of policy to support health needs.Methods. A search of state and federal policies on mental and physical illness was conducted, as well as detailed analysis of policy content and the relationships between policies, by applying the World Health Organization Mental Health Action Plan 2013-2020 as an evaluative framework.

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Prevalence and Predictors of Lipid and Glucose Monitoring in Commercially Insured Patients Treated With Second-Generation Antipsychotic Agents

Cited by 166 publications

References 33 publications

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

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

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

Applying the World Health Organization Mental Health Action Plan to evaluate policy on addressing co-occurrence of physical and mental illnesses in Australia

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