Metabolic screening below recommendations for kids treated with antipsychotics

Most children and adolescents taking second-generation antipsychotics are not being appropriately screened for glucose and lipid disturbances, despite current clinical recommendations advising such screening practices, according to the results of a new study.

In 2003, the Food and Drug Administration (FDA) required that a warning regarding an increased risk of hyperglycemia and diabetes mellitus be added to labeling for second-generation antipsychotic medications. The American Diabetes Association, the American Psychiatric Association, the North American Association for the Study of Obesity, and the American Association of Clinical Endocrinologists released a joint consensus statement in 2004 recommending that all patients treated with these agents should undergo metabolic screening and monitoring. Because the use of second-generation antipsychotics is increasing in pediatric patients, researchers in the current study sought to evaluate whether these screening recommendations were being followed in children and adolescents.

This retrospective, new-user cohort study (Arch Pediatr Adolesc Med. 2010;164[4];344-351) assessed Medicaid patients from California, Missouri, and Oregon who were aged 6 to 17 years, did not have preexisting diabetes or dyslipidemia, and began taking a second-generation antipsychotic medication (aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone) in 2005 (n=5,370). These patients were compared with a reference population of chronically ill children being treated with albuterol who were not receiving antipsychotics and for whom metabolic screening was not indicated (n=15,000). The researchers compared the rates of glucose testing and lipid testing in these 2 groups.

The strongest predictors of glucose testing in antipsychotic-treated patients included having an emergency department visit (adjusted odds ratio [AOR], 2.52), having multiple mental health comorbidities (AOR, 2.42), and having been hospitalized (AOR, 2.15). The strongest predictors of lipid testing included having multiple mental health comorbidities (AOR, 2.85), having at least 2 medical office visits during the study period (AOR, 1.88), and having serious mental illness (AOR, 1.51).

The authors pointed out that, although more antipsychotic-treated children received metabolic screening than did control patients in this study, the rates of screening in the antipsychotic population still fell far short of consensus screening recommendations. They called this finding "disturbing, given the general environment of public health concern surrounding increasing rates of obesity and type 2 diabetes in adolescents and given specific concerns about metabolic risk for children with psychiatric conditions." Commenting on the increased rates of metabolic disturbances among the antipsychotic-treated patients, the authors said, "The fact that only a few children were screened suggests that actual rates of metabolic abnormalities in these settings may be higher and that claims-based estimates available to state policy makers may underestimate true rates of these problems." They stated that "greater effort is needed to ensure consistent screening for all children receiving antipsychotic medications."