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Brief Reports   |    
Management of New Hyperglycemia in Patients Prescribed Antipsychotics
Kristen Viverito, Psy.D.; Richard Owen, M.D.; Dinesh Mittal, M.D.; Chenghui Li, Ph.D.; James Silas Williams, B.S.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300514
View Author and Article Information

The authors are with the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (e-mail: kristen.viverito@va.gov). Dr. Owen is also with the Department of Psychiatry and Dr. Li is also with the Division of Pharmaceutical Evaluation and Policy, both at the University of Arkansas for Medical Sciences, Little Rock.

Copyright © 2014 by the American Psychiatric Association


Objective  This study examined the extent to which patients found to have clinically significant hyperglycemia after beginning a new antipsychotic receive guideline concordant management.

Methods  This retrospective cohort analysis (N=403) used U.S. Department of Veterans Affairs databases and multivariable logistic regression models to examine the association of patient characteristics with the likelihood of receiving recommended management.

Results  Overall, 63% of patients (N=254) received at least one type of management action within 30 days of identification of hyperglycemia. A primary care encounter was the most common action. Weight management program encounter, nutrition encounter, diabetes clinic encounter, and change in antipsychotic medications were underutilized interventions. Counseling related to weight management, nutrition, and diabetes that occurred during other visits with providers was not measured. Older patients and female patients were less likely to receive timely management. Preexisting comorbidities inconsistently influenced management practices.

Conclusions  Timely hyperglycemia management actions were not recorded in administrative data for a sizable minority of patients. Further research is needed to determine the full extent of appropriate management actions in this context.

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Table 1Analysis of variables as predictors of management actions taken within 30 days of an abnormal glucose or hemoglobin A1c test among 403 veterans
Table Footer Note

a Oral hypoglycemic agent or insulin

Table Footer Note

b Within 360 days before or on the index prescription date

Table Footer Note

c Within 360 days before or 180 days after the index prescription date. Any psychotic condition was defined as schizophrenia, bipolar disorder, or other psychotic disorder.



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