Adherence to guidelines for glucose assessment in starting second-generation antipsychotics
Authors
Raebel, Marsha A.Penfold, Robert
McMahon, Ann W.
Reichman, Marsha
Shetterly, Susan
Goodrich, Glenn
Andrade, Susan E.
Correll, Christoph U.
Gerhard, Tobias
UMass Chan Affiliations
Meyers Primary Care InstituteDocument Type
Journal ArticlePublication Date
2014-11-01Keywords
AdolescentAntipsychotic Agents
Blood Glucose
Child
Child, Preschool
Cohort Studies
Diabetes Mellitus
Female
Humans
Hyperglycemia
Male
Practice Guidelines as Topic
Retrospective Studies
Endocrine System Diseases
Health Services Research
Pediatrics
Psychiatric and Mental Health
Psychiatry
Metadata
Show full item recordAbstract
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 chi(2) 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.Source
Pediatrics. 2014 Nov;134(5):e1308-14. doi: 10.1542/peds.2014-0828. Epub 2014 Oct 6. Link to article on publisher's siteDOI
10.1542/peds.2014-0828Permanent Link to this Item
http://hdl.handle.net/20.500.14038/37315PubMed ID
25287454Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1542/peds.2014-0828