Metabolic risks remain largely unmonitored in Medicaid patients taking antipsychotics

Jan 04, 2010

Despite government warnings and professional recommendations about diabetes risks associated with second-generation antipsychotic drugs, fewer than one-third of Medicaid patients who are treated with these medications undergo tests of blood glucose or lipid levels, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

In 2003, the (FDA) began requiring a warning on labels of second-generation —including olanzapine, fluoxetine and risperidone—describing an increased risk for and diabetes, according to background information in the article. The warning stated that glucose levels should be monitored in patients with diabetes, at risk for the disease or with symptoms of high . At the same time, the American Diabetes Association and American Psychiatric Association published a consensus statement describing the metabolic risks associated with second-generation antipsychotics and specifying a monitoring protocol for all patients receiving these medications.

Elaine H. Morrato, Dr.P.H., M.P.H., of the University of Colorado Denver, and colleagues studied laboratory claims data from the Medicaid population of three states (California, Missouri and Oregon) between 2002 and 2005. Metabolic testing (testing of blood glucose and ) rates were compared between a group of 109,451 patients receiving second-generation antipsychotics and a control group of 203,527 who began taking albuterol (an asthma drug) but not an antipsychotic. Rates were also compared before and after the FDA warning.

Initial testing rates for patients treated with second-generation antipsychotics were low—27 percent underwent glucose testing and 10 percent underwent lipid testing. The FDA warning was not associated with any increase in glucose testing and only a marginal increase in lipid testing rates (1.7 percent). "Testing rates and trends in second-generation antipsychotic-treated patients were not different from background rates observed in the albuterol control group," the authors write.

New prescriptions of olanzapine, which carries a higher metabolic risk, declined during the warning period. Prescriptions of the lower-risk drug aripiprazole increased, but this may also be attributable to the elimination of prior authorization for the drug in California during the same timeframe.

"Although this retrospective study was not able to identify or quantify reasons why laboratory screening did not increase after the FDA warnings, whereas prescribing practices did change, we might speculate on some possible explanations," the authors write. Switching to lower-risk drugs or avoiding drug treatment altogether may be simpler than the initiation of new screening procedures. In addition, although surveys have shown that psychiatrists are aware of the metabolic risk factors of these drugs, primary care providers who would generally order the necessary laboratory tests may not be.

"More effort is needed to ensure that patients who receive second-generation antipsychotic drugs are screened for diabetes and dyslipidemia and monitored for potential adverse drug effects, beginning with baseline testing of serum glucose and lipids, so that patients can receive appropriate preventive care and treatment," the authors conclude.

Explore further: FDA warning: men's testosterone drugs overused (Update)

More information: Arch Gen Psychiatry. 2010;67[1]:17-24.

add to favorites email to friend print save as pdf

Related Stories

New safety concern related to antipsychotic treatment

Dec 01, 2009

Overall, antipsychotic medications are reasonably effective, and fairly well tolerated treatments for mood and psychotic disorders. However, treatment with a number of antipsychotic medications is associated with weight ...

Recommended for you

FDA warning: men's testosterone drugs overused (Update)

Mar 03, 2015

The Food and Drug Administration is warning doctors against over-prescribing testosterone-boosting drugs for men, saying the popular treatments have not been established as safe or effective for common age-related ...

Early benefit assessment increases transparency for study data

Mar 03, 2015

Four years have passed since the introduction of the German Act on the Reform of the Market for Medicinal Products (AMNOG). AMNOG was primarily aimed at containing the increasing drug expenditure of the statutory health insurance ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.