TY  - JOUR
T1  - MEtabolic testing rates in 3 state medicaid programs after fda warnings and ada/apa recommendations for second-generation antipsychotic drugs
AU  - Morrato EH, Druss B, Hartung DM, et al
Y1  - 2010/01/01
N1  - 10.1001/archgenpsychiatry.2009.179
JO  - Archives of General Psychiatry
SP  - 17
EP  - 24
VL  - 67
IS  - 1
N2  - Context 
    In 2003, the Food and Drug Administration (FDA) required a warning on diabetes risk for second-generation antipsychotic (SGA) drugs. The American Diabetes Association (ADA) and American Psychiatric Association (APA) recommended glucose and lipid testing for all patients starting to receive SGA drugs.Objective 
    To characterize associations between the combined warnings and recommendations and baseline metabolic testing and SGA drug selection.Design 
    Interrupted time-series analysis.Setting 
    California, Missouri, and Oregon.Patients 
    A total of 109 451 individuals receiving Medicaid who began taking SGA medication and a control cohort of 203 527 patients who began taking albuterol but did not receive antipsychotic medication.Interventions 
    Prewarning and postwarning trends in metabolic testing were compared using laboratory claims for the cohort collected January 1, 2002, through December 31, 2005. Changes in SGA prescribing practices were similarly evaluated.Main Outcome Measures 
    Monthly rates of baseline serum glucose and lipid testing for SGA-treated and propensity-matched albuterol-treated patients and monthly share of new prescriptions for each SGA drug.Results 
    Initial testing rates for SGA-treated patients were low (glucose, 27%; lipids, 10%). The warning was not associated with an increase in glucose testing among SGA-treated patients and was associated with only a marginal increase in lipid testing rates (1.7%; P = .02). Testing rates and trends in SGA-treated patients were not different from background rates observed in the albuterol control group. New prescriptions of olanzapine (higher metabolic risk) declined during the warning period (annual share decline, 19.9%; P < .001). New prescriptions of aripiprazole (lower metabolic risk) increased during the warning period (share increase, 12.1%; P < .001) but may be attributable to the elimination of prior authorization in California during the same time frame. Quetiapine, risperidone, and ziprasidone use were not associated with the warning.Conclusions 
    In a Medicaid-receiving population, baseline glucose and lipid testing for SGA-treated patients was infrequent and showed little change following the diabetes warning and monitoring recommendations. A change in SGA drug selection consistent with intentions to reduce metabolic risk was observed.
SN  - 0003-990X
M3  - doi: 10.1001/archgenpsychiatry.2009.179
UR  - http://dx.doi.org/10.1001/archgenpsychiatry.2009.179
ER  -