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Published on: November 21, 2013
Metabolic screening in children receiving antipsychotic drug treatment
Elaine H Morrato1, Ginger E Nicol, David Maahs
1Department of Health Systems, Management,and Policy, Colorado School of Public Health, University of Colorado at Denver, Aurora, Colorado 80045, USA. Elaine.Morrato@ucdenver.edu
Insights
Most children starting second-generation antipsychotic (SGA) drugs did not receive recommended metabolic screening, despite guidelines. This highlights a gap in care for pediatric patients on these medications.
Area of Science:
- Pediatric Endocrinology
- Psychopharmacology
- Public Health
Background:
- Second-generation antipsychotics (SGA) are increasingly prescribed for children and adolescents.
- SGA treatment is associated with significant metabolic risks, including diabetes and dyslipidemia.
- Professional guidelines recommend regular metabolic screening for children on SGAs.
Purpose of the Study:
- To determine the rates of metabolic screening (glucose and lipid testing) in children initiating SGA treatment.
- To identify predictors associated with receiving metabolic screening.
- To estimate the incidence of metabolic disturbances in this pediatric population.
Main Methods:
- Retrospective cohort study using Medicaid claims data from California, Missouri, and Oregon (July 2004–June 2006).
- Included 5370 children (6–17 years) initiating SGA treatment and 15,000 control children taking albuterol.
- Outcome measures included serum glucose and lipid testing, and 6-month incidence of diabetes and dyslipidemia.
Main Results:
- Glucose screening was performed in 31.6% of SGA-treated children versus 12.6% of controls; lipid testing in 13.4% versus 3.1%.
- Predictors for screening included serious/multiple psychiatric diagnoses and intensive healthcare utilization.
- Incidence of glucose and lipid disorders was higher in SGA-treated children compared to controls.
Conclusions:
- A majority of children initiating SGA treatment in this public sector sample did not receive recommended metabolic screening.
- There is a critical need to improve adherence to metabolic monitoring guidelines for pediatric SGA users.
- Addressing screening gaps is essential to mitigate metabolic risks in children on SGAs.
Objectives:
To estimate metabolic screening rates, predictors of screening, and incidence of metabolic disturbances in children initiating second-generation antipsychotic (SGA) drug treatment.
Design:
A retrospective, new-user cohort study (between July 1, 2004, and June 30, 2006) using Medicaid claims data.
Settings:
California, Missouri, and Oregon.
Patients:
A total of 5370 children (aged 6-17 years) without diabetes mellitus taking SGA drugs and 15,000 children without diabetes taking albuterol (control individuals) [corrected] but no SGA drugs.
Intervention:
Findings 1 year after recommendations from the American Diabetes Association and American Psychiatric Association called for metabolic screening of patients receiving SGA drugs.
Outcome Measures:
Serum glucose and lipid testing, 6-month incidence of diabetes, and dyslipidemia disturbances.
Results:
Glucose screening was performed in 1699 (31.6% [95% confidence interval (CI), 30.4%-32.9%]) SGA-treated children vs 1891 (12.6% [12.1%-13.2%]) control individuals. Lipid testing was performed in 720 (13.4% [95% CI, 12.5%-14.4%]) SGA-treated children vs 458 (3.1% [2.8%-3.3%]) controls. In multivariate logistic regression analysis, children with serious and/or multiple psychiatric diagnoses and those who used health care services more intensively were more likely to receive metabolic screening. The case incidence of glucose and lipid disorders was higher in SGA-treated vs albuterol-treated children (8.9 per 1000 children [95% CI, 6.6%-11.8%] vs 4.9 per 1000 children [3.9%-6.2%]; and 9.7 per 1000 children [95% CI, 7.2%-12.7%] vs 4.6 per 1000 children [95% CI, 3.6%-5.8%], respectively).
Conclusion:
Most children starting treatment with SGA medications in this public sector sample did not receive recommended glucose and lipid screening.
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