Metabolic monitoring and control among patients with type 2 diabetes prescribed second generation antipsychotics

Annual monitoring of metabolic control is recommended for patients with type 2 diabetes (T2D) prescribed second-generation antipsychotics (SGA), with uncertain validity as a performance measure for health plans. To study the rates of metabolic monitoring and control in the three years after antipsychotic prescription following T2D diagnosis.

We used the electronic health record data from Epic Cosmos. We identified adult patients (n = 469,503) with newly diagnosed T2D between 2012 and 2021 as those who were prescribed SGA (6.9%), first-generation antipsychotics (FGA) (4.4%), or neither (88.7%). Rates of metabolic monitoring (weight, HbA1c, LDL, and estimated glomerular filtration rate using CKD-EPI 2021 [eGFR]) and control (HbA1c ≤8%, blood pressure ≤140/90 mmHg, and LDL ≤100 mg/dL) in the three years after first prescription of SGA, FGA or neither were modeled used logistic generalized estimating equations.

The sample was 52% female, 17% non-Hispanic Black, and 6.7% Hispanic; mean age was 63.8 years (SD: 13.1). In Year 1, relative to those prescribed neither, the adjusted rates of monitoring of weight were similar but HbA1c (Neither: 92.3%[95%CI: 88.4-95.0], SGA: 81.9%[95%CI: 73.4-88.1], FGA: 73.6%[95%CI: 62.6-82.3]) and LDL (Neither: 71.5%[95%CI: 62.5-79.0], SGA: 57.8%[95%CI: 47.0-68.0], FGA: 49.9%[95%CI: 38.7-61.1]) were lower, among those prescribed antipsychotics, with overlapping confidence intervals. eGFR was monitored more frequently among patients prescribed SGA and FGA only in Year 1 (Neither: 66.4%[95%CI: 57.1-74.7], SGA: 76.3%[95%CI: 67.4-83.4], FGA: 82.0%[95%CI: 73.5-88.2]). Rates decreased over time for all groups across all outcomes. Rates of metabolic control were higher than national averages, but similar over time and did not differ between groups.

Declining rates of metabolic monitoring, independent of antipsychotic prescription, present opportunities for quality improvement initiatives among patients with T2D.