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Importance: In recent decades, youth have increasingly been prescribed antipsychotic medications to treat a range of mental health conditions. These medications are associated with metabolic disturbances elevating type 2 diabetes risk, but ADA-recommended metabolic screening rates have stagnated at low levels (<50%) for youth treated with antipsychotics. We examined 5-year metabolic screening trends and predictors for this population in a large, integrated health system. Methods: In this serial cross-sectional study, we assessed metabolic screening (fasting glucose or hemoglobin A1c test) from health record data for 4,541 youth age 10-21 starting antipsychotic treatment in Kaiser Permanente Northern California during 2013-2017. We evaluated time and demographic predictors of metabolic screening within 2 years of medication start using logistic regression. To understand screening trends by age, sex, and racial groups, we estimated additional models with time x group interaction terms. Results: Participants were mean ± SD age 16.9 ± 3.0; 52% were boys. Half were racial minorities (22% Hispanic/Latino; 13% Black; 12% Asian/Nat. Hawaiian/Pac. Islander [ANHPI]). Screening significantly increased over the 5 cohort years (adj. rates rising from 54% to 64%). Younger participants, girls, and ANHPI and Hispanic/Latino participants had higher screening rates overall (all p<0.05); time trends did not differ by age, sex, or race. Conclusions and Relevance: In this large health system, which has established processes to promote preventive care (e.g., automatic patient reminders), metabolic screening has increased for youth treated with antipsychotics and exceeds those reported in other samples. Future research should examine processes contributing to this upward trend and identify remaining barriers to achieving ADA-recommended metabolic screening rates for this vulnerable population. Disclosure L. Hsueh: None. N. Slama: None. S. Spalding: None. S. Sterling: None. E. Iturralde: None. Funding Permanente Medical Group

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