October 22, 2014
Second-Generation Antipsychotics: Too LittleDenver—Pharmacists filling second-generation antipsychotics prescriptions for patients 18 or younger for the first time should consider raising some questions about metabolic screening.
For more than a decade, guidelines have recommended metabolic screening with second-generation antipsychotics (SGAs), but very few children and adolescents starting the therapy have baseline glucose assessed even now.
That’s according to a new study led by the Kaiser Permanente Colorado Institute for Health Research and published recently in the journal Pediatrics.
In 2003, the FDA issued warnings about hyperglycemia and diabetes with SGAs, and guidelines recommending metabolic screening were issued in 2004, according to the study’s background information. In 2010, prescribing information for olanzapine, marketed as Zyprexa, was changed, urging clinicians to “consider the increased potential (in adolescents as compared with adults) for weight gain and hyperlipidemia.”
The Kaiser Permanente study group included 16,304 young people ages 2 through 18 beginning SGA therapy between January 1, 2006, through December 31, 2011, across 10 sites. Most were boys, 60%, with a mean age of 12.8 years.
Researchers reviewed records for fasting/random glucose or hemoglobin A1c testing to see if baseline glucose had been measured. They found that baseline glucose was established in only 11% of the patients between 90 days before and 3 days after first dispensing SGAs.
The most common SGA prescribed was risperidone, which was initiated in 43%. The highest rate of assessment, however, occurred with olanzapine, followed by quetiapine, aripiprazole, and risperidone.
In addition, assessment rates were higher in integrated healthcare systems, in older patients (16-18), in the year 2007, and with females.
“Few children and adolescents starting SGA have baseline glucose assessed,” the authors conclude. “This is concerning because those at high diabetes risk may not be identified. Further, lack of screening impedes determining the contribution of SGAs to hyperglycemia development.”
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