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Adherence to guidelines for glucose assessment in starting second-generation antipsychotics
Marsha A Raebel1, Robert Penfold2, Ann W McMahon3
1Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado; marsha.a.raebel@kp.org.
Pediatrics
|October 8, 2014
Summary
Few youth initiating second-generation antipsychotics (SGAs) receive baseline glucose screening. This is concerning, as it may miss identifying high diabetes risk in children and adolescents.
Area of Science:
- Pediatric Endocrinology
- Psychopharmacology
- Public Health
Background:
- Second-generation antipsychotics (SGAs) are associated with hyperglycemia and diabetes risk.
- Metabolic screening guidelines for youth on SGAs have existed since 2004.
- Contemporary practices for glucose screening in this population are not well understood.
Purpose of the Study:
- To evaluate the rates and patterns of baseline glucose assessment in youth initiating SGAs.
- To identify factors associated with glucose screening in this cohort.
Main Methods:
- A retrospective cohort study of 16,304 youth (ages 2-18) initiating SGAs between 2006-2011.
- Baseline glucose assessment (fasting/random glucose or HbA1c) was defined within 90 days before to 3 days after first SGA dispensing.
- Statistical analyses included chi-squared tests and logistic regression to assess differences in screening.
Main Results:
- Only 11% of youth initiating SGAs received baseline glucose assessment.
- Screening rates varied significantly by SGA type, healthcare site, age, year, and gender.
- Youth starting olanzapine were more likely to be screened compared to those starting quetiapine, aripiprazole, or risperidone.
Conclusions:
- Baseline glucose assessment is infrequent among pediatric and adolescent SGA initiators.
- This low screening rate poses a risk for undiagnosed diabetes and hinders understanding of SGA-induced hyperglycemia.
- Improved adherence to metabolic screening guidelines is crucial for this vulnerable population.
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