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Metabolic testing underutilized in adults receiving antipsychotics

Recent findings indicate that progress has been made regarding glucose testing among adults receiving antipsychotics, but lipid testing remains underutilized.

“Antipsychotic medications are associated with substantial weight gain, as well as changes in insulin sensitivity and lipid metabolism, which increase the risk of diabetes and cardiovascular disease,” Elaine H. Morrato, DrPH, MPH, of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, said in a press release.

To assess glucose and lipid testing rates among adults newly prescribed antipsychotics in a state Medicaid program, researchers conducted a retrospective cohort study of Missouri Medicaid administrative claims data from 2010 to 2012. Analysis included 9,316 adults with a mean age of 37.6 years.

Overall, 24.3% of the cohort initiated antipsychotic medication in a community mental health center (CMHC), 27.6% initiated in a non-CMHC behavioral health setting, 24.3% initiated in a primary care setting, and 23.8% had an unknown initiation setting.

Annual testing rates were 79.6% for glucose and 41.2% for lipids.

Patient factors and health care utilization were most strongly associated with failure to test glucose and lipids.

Findings from glucose modeling indicated individuals with older age (OR = 0.64; 95% CI, 0.55-0.74), a diagnosis of schizophrenia or bipolar disorder (OR = 0.55; 95% CI, 0.44-0.67), cardiometabolic comorbidity such as dyslipidemia (OR = 0.28; 95% CI, 0.22-0.37) or hypertension (OR = 0.59; 95% CI, 0.5-0.69), and greater outpatient utilization (OR = 0.33; 95% CI, 0.28-0.39) were more likely to receive testing.

Analysis of prescriber practice information indicated lower failure to receive glucose testing if individuals received care at a CMHC (OR = 0.74; 95% CI, 0.64-0.85) or if the prescriber was a primary care practitioner (OR = 0.81; 95% CI, 0.66-1).

Specialty setting of the initiating prescriber was not associated with lipid testing.

“Adults with serious mental illness should receive appropriate clinical preventive services, including regular and early glucose and lipid testing,” the researchers wrote. “Progress has been made to improve diabetes testing, but lipid testing remains particularly underutilized in adults receiving antipsychotic medication. Given the large proportion of antipsychotics prescribed by non–mental health care professionals, education and performance improvement initiatives should also be targeted for these settings. Consistency and redundancy in messaging about the advisability of annual screening is important, and professional associations, federal agencies, and health care organizations should reach consensus on testing recommendations so that they reinforce the same message.” – by Amanda Oldt

Disclosure: Morrato reports receiving consulting fees and travel funds from Merck and Janssen Pharmaceutical, and research funding from Janssen Pharmaceuticals. Please see the full study for a list of all authors’ relevant financial disclosures.