Category: Federal Forum Posters
Purpose: Metabolic syndrome is a known risk factor for the development of cardiovascular disease and type 2 diabetes mellitus. The link between antipsychotic medication therapy and the development of metabolic syndrome is well established. Appropriate monitoring while on antipsychotic medication may be able to identify metabolic abnormalities before they progress. This project examined metabolic monitoring practices for patients prescribed antipsychotic medication at a Veterans Affairs Health Care System. The primary objectives were to determine the incidence of metabolic syndrome and to describe monitoring practices of primary care providers for patients treated on antipsychotic medications.
Methods: A single-center, retrospective medication use evaluation was conducted using electronic medical records to identify outpatients receiving antipsychotic medication. Patients were included if their antipsychotic therapy was managed by a primary care provider and if they had newly initiated antipsychotic medication between July 1, 2013 and July 1, 2017. Patients taking antipsychotics for less than one year, more than five years, or as needed were excluded. Of 93 patients randomly selected and reviewed, 32 patients met inclusion criteria. The electronic medical record was utilized to collect data including lipid panels, blood glucose, hemoglobin A1C, blood pressure, weight, and waist circumference measurements. Data was collected from immediately prior to antipsychotic initiation until July 1, 2018. The metabolic syndrome status of each patient was determined for each lab cycle based on pre-specified diagnostic criteria. The primary endpoint was the percentage of patients with all recommended parameters monitored within the first year of antipsychotic treatment. Secondary endpoints included the number of patients that developed metabolic syndrome while on antipsychotic treatment, the frequency of monitoring for each metabolic parameter, and the percentage of labs ordered at baseline, 12-weeks, 6-months, and annually. Descriptive analysis was used to evaluate the endpoints.
Results: Twenty-one patients (66%) received complete metabolic monitoring during their first year of treatment. Waist circumference was identified as the most frequently missed monitoring parameter. When waist circumference was excluded, complete monitoring improved to 27 patients (84%) within the first year of treatment. Sixteen patients met diagnostic criteria for metabolic syndrome prior to antipsychotic initiation, and three patients (9%) developed metabolic syndrome over the course of treatment. Blood pressure was monitored most frequently (90% of patients), while waist circumference was monitored least frequently overall (40% of patients). Weight/BMI and blood pressure were measured most often at baseline; whereas monitoring of lipid panels, blood glucose, and hemoglobin A1C increased over time. Baseline labs were ordered for 69% of patients, 12-week labs were ordered for 25% of patients, one-year follow-up labs were ordered for 77% of patients, and two-year follow-up labs were ordered for 96% of patients. 100% of patients received monitoring for at least one metabolic parameter during the first year of treatment.
Conclusion: Based on this analysis, a majority of patients received complete metabolic monitoring within the first year of treatment. Over the course of antipsychotic treatment, some patients developed metabolic syndrome. With respect to metabolic monitoring, lipid panels, waist circumference, and hemoglobin A1C were most often missed by primary care providers. Increased provider awareness and patient education could further improve current practice and ensure early identification of metabolic syndrome development in patients receiving antipsychotic treatment.
Shannon James– PGY1 Resident, New Mexico VA Health Care System, Albuquerque, NM