• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (38)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Nutritional and Metabolic Disorders  • Lipids and Lipid Disorders  • Psychiatry  • Psychopharmacology  • Screening  • Drug Therapy  • Adverse Effects  • Drug Therapy, Other  • Endocrine Diseases  • Diabetes Mellitus  • Alert me on articles by topic  Social Bookmarking   What's this?

Elaine H. Morrato, DrPH, MPH; Benjamin Druss, MD, MPH; Daniel M. Hartung, PharmD, MPH; Robert J. Valuck, PhD; Richard Allen, MS; Elizabeth Campagna, MS; John W. Newcomer, MD

Arch Gen Psychiatry. 2010;67(1):17-24.

Context  In 2003, the Food and Drug Administration (FDA) required a warning on diabetes risk for second-generation antipsychotic (SGA) drugs. The American Diabetes Association (ADA) and American Psychiatric Association (APA) recommended glucose and lipid testing for all patients starting to receive SGA drugs.

Objective  To characterize associations between the combined warnings and recommendations and baseline metabolic testing and SGA drug selection.

Design  Interrupted time-series analysis.

Setting  California, Missouri, and Oregon.

Patients  A total of 109 451 individuals receiving Medicaid who began taking SGA medication and a control cohort of 203 527 patients who began taking albuterol but did not receive antipsychotic medication.

Interventions  Prewarning and postwarning trends in metabolic testing were compared using laboratory claims for the cohort collected January 1, 2002, through December 31, 2005. Changes in SGA prescribing practices were similarly evaluated.

Main Outcome Measures  Monthly rates of baseline serum glucose and lipid testing for SGA-treated and propensity-matched albuterol-treated patients and monthly share of new prescriptions for each SGA drug.

Results  Initial testing rates for SGA-treated patients were low (glucose, 27%; lipids, 10%). The warning was not associated with an increase in glucose testing among SGA-treated patients and was associated with only a marginal increase in lipid testing rates (1.7%; P = .02). Testing rates and trends in SGA-treated patients were not different from background rates observed in the albuterol control group. New prescriptions of olanzapine (higher metabolic risk) declined during the warning period (annual share decline, 19.9%; P < .001). New prescriptions of aripiprazole (lower metabolic risk) increased during the warning period (share increase, 12.1%; P < .001) but may be attributable to the elimination of prior authorization in California during the same time frame. Quetiapine, risperidone, and ziprasidone use were not associated with the warning.

Conclusions  In a Medicaid-receiving population, baseline glucose and lipid testing for SGA-treated patients was infrequent and showed little change following the diabetes warning and monitoring recommendations. A change in SGA drug selection consistent with intentions to reduce metabolic risk was observed.

Author Affiliations: Department of Pediatrics, School of Medicine, and Colorado School of Public Health, Department of Health Services Management and Policy (Dr Morrato), Department of Clinical Pharmacy, School of Pharmacy (Drs Morrato and Valuck), and Colorado Health Outcomes Program, University of Colorado Denver, Aurora, Colorado (Dr Morrato and Ms Campagna); Emory University, Rollins School of Public Health, Atlanta, Georgia (Dr Druss); Oregon State University College of Pharmacy, Oregon Health & Science University, Portland (Dr Hartung); Peak Statistical Services, Evergreen, Colorado (Mr Allen); the Departments of Psychiatry, Psychology, and Medicine, and the Center for Clinical Studies, Washington University School of Medicine, St Louis, Missouri (Dr Newcomer).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of General Psychiatry
Arch Gen Psychiatry. 2010;67(1):5.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Antipsychotic Medication Use Among Children and Risk of Diabetes Mellitus
Andrade et al.
Pediatrics 2011;128:1135-1141.
ABSTRACT | FULL TEXT  

American Diabetes Association Postgraduate Meetings--2011
Bloomgarden
Diabetes Care 2011;34:e164-e169.
FULL TEXT  

Targeted Intervention to Improve Monitoring of Antipsychotic-Induced Weight Gain and Metabolic Disturbance in First Episode Psychosis
Thompson et al.
Aust N Z J Psychiatry 2011;45:740-748.
ABSTRACT | FULL TEXT  

Guidelines for screening and monitoring of cardiometabolic risk in schizophrenia: systematic evaluation
De Hert et al.
Br. J. Psychiatry 2011;199:99-105.
ABSTRACT | FULL TEXT  

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology
Barnes and the Schizophrenia Consensus Group of the British A
J Psychopharmacol 2011;25:567-620.
ABSTRACT | FULL TEXT  

Metabolic Screening in Children Receiving Antipsychotic Drug Treatment
Morrato et al.
Arch Pediatr Adolesc Med 2010;164:344-351.
ABSTRACT | FULL TEXT