Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Raebel, Marsha A.; Penfold, Robert B.; McMahon, Ann; Reichman, Marsha E.; Shetterly, Susan; Goodrich, Glenn K.; Andrade, Susan E.; Correll, Christoph U.; Gerhard, Tobias

doi:10.1542/peds.2014-0828

Cited by 35 publications

(39 citation statements)

References 29 publications

(40 reference statements)

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“…As part of the ongoing metformin for overweight and obese children with bipolar spectrum disorders treated with SGA (MOBILITY) study (PCS-1406-19276; ClinicalTrials.gov identifier: NCT02515773), a randomized, large, simple pragmatic clinical trial examining metformin as standard of care for overweight and obese youth (8-19 year old) with past or present bipolarspectrum illness who require treatment with SGAs, rates of metabolic monitoring are being evaluated as part of the battery of outcome measures. Interim findings suggest suboptimal baseline monitoring of subjects (66.9% any lab, 66.1% glucose, 61.0% triglycerides, and 60.4% cholesterol), although higher than previously published studies that have reported rates of glucose (15%-50%) and lipid (13%) screenings in youth initiating SGA treatment (Morrato et al 2010;Raebel et al 2014). Although the MOBILITY trial is intended to reflect ''real-world'' clinical practice through its pragmatic study design, there is likely additional attention to laboratory tests compared with usual care because of the study's emphasis on metabolic monitoring.…”

Section: Introductionmentioning

confidence: 65%

Metabolic Monitoring Rates of Youth Treated with Second-Generation Antipsychotics in Usual Care: Results of a Large US National Commercial Health Plan

Hayden

Horter

Parsons

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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Objectives: To examine metabolic monitoring rates in commercially insured children and adolescents treated with a secondgeneration antipsychotic (SGA) during calendar years (CYs) 2016 and 2017. Methods: In this retrospective study, data were collected from a large national commercial health plan for the period covering January 1, 2016 to December 31, 2017. Commercially insured children and adolescents, aged 8-19 years with ‡2 SGA prescription claims during the CY, were identified for the CY2016 and CY2017 cohorts. The primary outcome of interest was the percentage of subjects with any glucose or lipid metabolism parameter monitoring. Other calculated metabolic testing rates included glucose, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), other cholesterol (including triglycerides), and combined glucose and lipid metabolism testing (‡1 test for blood glucose or HbA1c and ‡1 test for LDL-C or other cholesterol). Results: In CY2016 and CY2017, 1502 and 1239 subjects, respectively, were identified for this study. The most common psychiatric diagnoses in CY2016 and CY2017 were major depressive disorder (57.1%, 56.5%, respectively), anxiety disorders (42.9%, 47.5%), attention-deficit/hyperactivity disorder (41.6%, 45.8%), and bipolar disorder (24.1%, 25.9%). The rate of any metabolic testing was 53.5% in CY2016 and 51.3% in CY2017. Glucose testing (50.3%, 46.9%, respectively) was most common in both CYs, followed by LDL-C testing (31.2%, 28.5%). Rates of combined glucose and lipid metabolism testing were 30.7% in CY2016 and 26.9% in CY2017. Conclusions: Given the known potential for adverse cardiometabolic effects, rates of metabolic monitoring associated with SGA use in children and adolescents urgently need to be improved. There is a critical need for understanding barriers to routine monitoring, particularly of lipids, and developing interventions to enhance metabolic monitoring.

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Section: Introductionmentioning

confidence: 65%

Metabolic Monitoring Rates of Youth Treated with Second-Generation Antipsychotics in Usual Care: Results of a Large US National Commercial Health Plan

Hayden

Horter

Parsons

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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“…However, the content and schedule of the physical evaluations and follow-up practices of SGA medications have been diverse in child psychiatric clinical work (7,39,(44)(45)(46), as was also observed in this study. Only about one-third of the study patients had undergone a physical evaluation at SGA initiation.…”

Section: Discussionmentioning

confidence: 54%

“…Recommendations and follow-up protocols seem to be helpful in clinical work and appear to increase monitoring and possibly have an effect on prescribing practices (7,43,44). Despite the already existing recommendations, there has been a lag in the translation of research evidence into clinical practice (39,45). Rates of metabolic monitoring of SGA have been low according to several studies.…”

Section: Introductionmentioning

confidence: 99%

Clinical use of second-generation antipsychotics in children

Kakko

Pihlakoski

Salmelin

et al. 2017

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: The use of second-generation antipsychotic (SGA) medication among child and adolescent psychiatric patients has increased worldwide in recent years. The increase appears to have been more extensive in the USA than in European countries, but the tendency is similar. However, after a peak the use seems to have declined in the USA. Simultaneously with the increasing numbers, the duration of SGA use has lengthened, indications have broadened, and off-label use has increased. Despite existing follow-up recommendations and evidence for the metabolic adverse effects of SGAs in children, research evidence has not translated into clinical practice. Objective: The aim of this study was to assess the clinical use and follow-up practices of SGA medication among child psychiatric patients of one university hospital in Finland. Method: This retrospective patient report-based study was conducted at the Child Psychiatric Clinic of Tampere University Hospital, Finland. The study sample consisted of 133 patients who were younger than 13 years when initiating SGA treatment and had an ongoing SGA medication during the study period. The study sample was divided into two groups according to diagnosis to examine whether there were differences between patients with an autistic or a developmental disorder (F83-84) and patients with other psychiatric diagnoses. Results: This study showed that SGA use in children younger than 13 years was mainly off-label. Irrespective of diagnosis, the most common indication was aggression. Especially children with psychiatric diagnoses other than developmental disorders had multiple socio-demographic risk factors and adverse life experiences in their background. The follow-up practices were diverse and partly irregular. Conclusions: A need for systematic SGA monitoring practices and dialogue between the medical specialities treating children and their families is evident.

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“…Antipsychotic medications should be used only when required (eg, due to failure of other therapeutic options or absence of clinically appropriate alternatives), prioritising presumably less metabolically risky agents, and adhering to metabolic screening (at baseline) and monitoring (during treatment) recommendations. Current evidence suggests that pretreatment glucose screening recommendations for paediatric patients are not being followed 5. Sex differences in the risk of new-onset type 2 diabetes are interesting, but metabolic screening and monitoring practices should not differ according to patient sex.…”

Section: Do These Results Change Your Practices and Why?mentioning

confidence: 99%

More evidence of an association between antipsychotic drugs and the risk of diabetes in children and adolescents: a population-based study

Bobo

2015

Evid Based Mental Health

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FROM: Nielsen RE, Laursen MF, Vernal DL, et al. Risk of diabetes in children and adolescents exposed to antipsychotics: a nationwide 12-year case-control study. J Am Acad Child Adolesc Psychiatry 2014;53:971-9.e6.WHAT IS ALREADY KNOWN ON THIS TOPIC Second generation antipsychotics have been linked with heightened risk of clinically significant weight gain and adverse metabolic effects in adults, including new-onset type 2 diabetes. 1 The use of these drugs has increased among children and adolescents in recent years, raising similar concerns about the risk of new-onset type 2 diabetes in that age group. Two previous large-scale epidemiological studies have reported an increase in such risk. 2 3 METHODS OF THE STUDYThis was a retrospective, case-control study of 48 299 paediatric patients living in Denmark during the study period 1 January 1999 through 30 June 2010. Cohort members, exposures, outcomes and covariates for analysis were identified (or ascertained) using linked electronic medical care and prescription registers maintained by the Danish healthcare system. Eligible persons had evidence of a psychiatric disorder diagnosis before the age of 18 years and no evidence of diagnosed eating disorders or diabetes. The main exposure group consisted of psychiatrically diagnosed children who filled at least one prescription for a first-or second-generation antipsychotic drug. Remaining cohort members were considered unexposed. The exposure groups were compared on the risk of type 2 diabetes, defined as filling at least one prescription for an oral hypoglycaemic medication. Follow-up began for the exposed group on the date of an index antipsychotic prescription fill. For the unexposed group, follow-up began on the date of psychiatric diagnosis, plus a random time interval based on the distribution of time from psychiatric diagnosis to filling an index antipsychotic prescription in the exposed group. For both groups, follow-up ended with an oral hypoglycaemic medication prescription fill, death or end of the study period.WHAT DOES THIS PAPER ADD ▸ This study supports findings from previous research in children and youth of an association between antipsychotics and new-onset diabetes in general 2 and type 2 diabetes in particular, 3 but extend them to a nationwide European sample. ▸ The difference in the observed risk of new-onset type 2 diabetes between exposed and non-exposed groups was small (0.45%). ▸ Being female was the strongest independent variable predicting type 2 diabetes onset in the cohort as a whole (OR=4.48, 95% CI 2.90 to 6.91). Among the antipsychotic-exposed, the risk of type 2 diabetes onset was also higher for females (number needed to harm (NNH)] 137, 95% CI 118 to 164) than for males (NNH=455, 95% CI 366 to 602). LIMITATIONS▸ Important factors (such as high baseline body mass index or more severe underlying psychiatric illnesses) may have been overrepresented in the exposed group. ▸ Intensity of medical surveillance could have been higher in the exposed group, leading to higher diabetes detection...

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Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics

Cited by 35 publications

References 29 publications

Metabolic Monitoring Rates of Youth Treated with Second-Generation Antipsychotics in Usual Care: Results of a Large US National Commercial Health Plan

Metabolic Monitoring Rates of Youth Treated with Second-Generation Antipsychotics in Usual Care: Results of a Large US National Commercial Health Plan

Clinical use of second-generation antipsychotics in children

More evidence of an association between antipsychotic drugs and the risk of diabetes in children and adolescents: a population-based study

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