0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

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

Abstract

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.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
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.

+

References

Colton  CW;  Manderscheid  RW:  Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states.  Preventing Chronic Disease 3:A42, 2006
[PubMed]
 
Kilbourne  AM;  Ignacio  RV;  Kim  HM  et al:  Are VA patients with serious mental illness dying younger? Psychiatric Services 60:589, 2009
[CrossRef] | [PubMed]
 
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, et al:  Consensus development conference on antipsychotic drugs and obesity and diabetes.  Diabetes Care 27:596–601, 2004
 
Newcomer  JW;  Hennekens  CH:  Severe mental illness and risk of cardiovascular disease.  JAMA 298:1794–1796, 2007
[CrossRef] | [PubMed]
 
McCloughen  A;  Foster  K:  Weight gain associated with taking psychotropic medication: an integrative review.  International Journal of Mental Health Nursing 20:202–222, 2011
[CrossRef] | [PubMed]
 
Warning About Hyperglycemia and Atypical Antipsychotic Drugs. Silver Spring, Md, US Food and Drug Administration, 2004
 
Mittal  D;  Li  C;  Williams  JS  et al:  Monitoring veterans for metabolic side effects when prescribing antipsychotics.  Psychiatric Services 64:28–35, 2013
[CrossRef] | [PubMed]
 
Das  C;  Mendez  G;  Jagasia  S  et al:  Second-generation antipsychotic use in schizophrenia and associated weight gain: a critical review and meta-analysis of behavioral and pharmacologic treatments.  Annals of Clinical Psychiatry 24:225–239, 2012
[PubMed]
 
Guenette  MD;  Hahn  M;  Cohn  TA  et al:  Atypical antipsychotics and diabetic ketoacidosis: a review.  Psychopharmacology 226:1–12, 2013
[CrossRef] | [PubMed]
 
American Diabetes Association:  Standards of medical care in diabetes—2013.  Diabetes Care 36(suppl 1):S11–S66, 2013
[CrossRef] | [PubMed]
 
Fauci  AS;  Braunwald  E;  Kasper  DL  et al:  Harrison's Principles of Internal Medicine .  New York,  McGraw-Hill Professional, 2008
 
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, et al:  Consensus development conference on antipsychotic drugs and obesity and diabetes.  Obesity Research 12:362–368, 2004
[CrossRef] | [PubMed]
 
Allison  DB;  Mentore  JL;  Heo  M  et al:  Antipsychotic-induced weight gain: a comprehensive research synthesis.  American Journal of Psychiatry 156:1686–1696, 1999
[PubMed]
 
Nussbaum  AM;  Stroup  TS:  Paliperidone for treatment of schizophrenia.  Schizophrenia Bulletin 34:419–422, 2008
[CrossRef] | [PubMed]
 
Lieberman  JA;  Stroup  TS;  McEvoy  JP  et al:  Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.  New England Journal of Medicine 353:1209–1223, 2005
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 39.  >
APA Practice Guidelines > Chapter 4.  >
APA Practice Guidelines > Chapter 4.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 49.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 26.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
APA Guidelines
PubMed Articles
Ageing: Live faster, die younger. Nature 2014;508(7494):S16-7.
A case of acute pancreatitis associated with risperidone treatment. Clin Psychopharmacol Neurosci 2014;12(1):67-8.