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 Food and Drug Administration (FDA) began requiring a warning on labels of second-generation antipsychotics—including olanzapine, fluoxetine and risperidone—describing an increased risk for high blood sugar 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 blood glucose. 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 lipid levels) 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.