Glucose monitoring in new users of second-generation antipsychotics in older people

Abstract

Objective Treatment guidelines published world-wide have highlighted concerns of increased metabolic risks associated with second-generation antipsychotics (SGAs).

The aim of the study was to evaluate blood glucose monitoring rates for SGA new users in older people aged 65 years and above during the study period 2006–2012, and investigate the pre-post 2007 Best Practice Advocacy Centre’s (bpacnz) glucose monitoring recommendation in New Zealand.

Methods The study was a population-based retrospective cohort of SGA new users (365 days without pre-exposure to antipsychotics). Pharmaceutical collections data were extracted and used to identify older people dispensed SGAs and linked to the National Minimum Dataset and Laboratory Claims collection. WHO Methodology’s Anatomical Therapeutic Chemical method’s classification was used to characterise the SGAs dispensed.

Results Of the 25,603 new users dispensed SGAs, 63.5% received glycaemic control monitoring at least once during the study period. Of these, only 20.1% were monitored at baseline, 38.7% were monitored for glycaemic control within the first 90 days. Glycaemic control monitoring within the first 180 days increased to more than half (57.5%) of the SGA new users. Proportion of individuals monitored were independent (χ2 = 6.1; P = 0.4) of pre-post bpacnz recommendation.

Conclusions Blood glucose monitoring was underutilized in new SGA users. No significant improvement in glycaemic control monitoring was observed after the 2007 bpacnz consensus statement release at baseline, 90 days and at 180 days. Prescribers must be cautioned about the metabolic risks posed by SGAs and recommend glycaemic control monitoring.