Metabolic Monitoring among Patients with Type 2 Diabetes Prescribed Second Generation Antipsychotics

Annual metabolic monitoring is strongly recommended for patients with type 2 diabetes (T2D) prescribed second-generation antipsychotics (SGA). Our objective was to study the rates of monitoring and control in the period after index SGA prescription following T2D diagnosis, relative to those prescribed first-generation antipsychotics (FGA) and neither. Among 469,503 adults in Epic Cosmos, we estimated therates ofmonitoring(%) ofweight, HbA1c, LDL, and renal function for Years 1 to 3 using marginal logistic models. We adjusted for demographic, clinical covariates, encounter frequency, and Charlson Comorbidity Index. Despite more healthcare visits, SGA and FGA groups had declining monitoring rates across all years. Relative to those prescribed neither, renal function was monitored more frequently among patients prescribed SGA and FGA only in Year 1, while HbA1c and LDL were monitored less for all years. Rates ofmetabolic control were higher than national averages, but similar over time and did not differ between groups. Poor metabolic monitoring following SGA prescription may hinder risk management for T2D complications among this vulnerable population.