Monitoring Glucose Regulation Parameters in Veterans Living with Schizophrenia-Related Disorders and Switched from One Second-Generation Antipsychotic to Another

Garman PM, Ried LD, Bengston MA, Hsu C. Monitoring Glucose Regulation Parameters in Veterans Living with Schizophrenia-Related Disorders and Switched from One Second-Generation Antipsychotic to Another. Poster session presented at: Academy of Managed Care Pharmacy Annual Meeting; 2007 Apr 13; San Diego, CA.

Background: Glucose dysregulation in schizophrenia patients is linked to second-generation antipsychotic (SGA) medications. Introduction: It is crucial that patients living with schizophrenia receive baseline glucose screening and routine monitoring. Methods: Our objectives were to 1) describe the proportion of veterans with schizophrenia-related disorders monitored and 2) examine the influences of social-demographic characteristics, hypoglycemic drug treatment, and prior monitoring on the occurrence of monitoring glucose regulation after switching SGAs. We abstracted automated medical, prescription, and administrative data from veterans (n = 1,826) who switched SGAs and were diagnosed with schizophrenia-related disorders. Outcome variables were fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c). Cumulative monitoring was calculated in 3-month increments, 180 days prior and 365 days after the index date. Predictors of glucose monitoring 1-year after switching were analyzed using multivariate logistic regression models. Results: Most veterans were male (92%) and averaged 51.6±10.6 years. The majority were White (55%), followed by Black (25%), unspecified (10%), Hispanic (9%), Asian and American Indian < 1%. Within one year after switching, 81% had a laboratory result for FBG or HbA1c. The 1-year post switch cumulative monitoring FBG and HbA1c was 80% and 31%, respectively. FBG was more likely to be monitored 1-year post SGA switch if they were monitored prior to the switch (odds ratio [OR = 3.21, p < .01), using hypoglycemic medications before the switch (OR = 1.80, p < .01), or ≥50 years (OR = 1.39, p = .01). HbA1c was more likely to be monitored if the veteran was using hypoglycemic medications before the switch (OR = 7.71, p < .01) or monitored beforehand (OR = 6.51, p < .01), ≥50 years (OR = 1.60, p < .01) or nonwhite (OR = 1.39, p = .01). Conclusions: Most veterans with schizophrenia-related disorders were monitored for glucose dysregulation within 1-year of switching SGAs. Veterans ≥50 years and receiving hypoglycemic drug treatment were most likely to be monitored after switching SGAs. Switching SGAs should trigger monitoring to allow detection of changes in glucose regulation.