Copyright © 2009 CME Outfi tters, LLC Monitoring Lipids in Patients Prescribed Atypical Antipsychotics: The Ideal and Reality

About 5 to 7 years ago, metabolic changes associated with use of atypical antipsychotic agents began being investigated and identified. This led, in 2004, to the FDA requesting manufacturers of atypical antipsychotics to add a warning regarding the risk of hyperglycemia and diabetes to their prescribing information.1 Around the same time, joint consensus recommendations from four key national organizations—the American Diabetes Association, the American Psychiatric Association, the American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity—were developed to address the need for metabolic monitoring in patients prescribed atypical antypsychotics.2,3 Specifically, the recommendation was that “all patients receiving second-generation antipsychotics should have fasting blood glucose and lipid levels determined at baseline and after 12 weeks of treatment.” More recently, a quality measure has been developed by the The STAndards for BipoLar Excellence (STABLE) Project that assesses the percentage of patients diagnosed with bipolar disorder and treated with an atypical antipsychotic agent who received at least one assessment for hyperlipidemia within the initial 16-week period of treatment.4 Actual Practice Studies suggest that lipid monitoring in patients being treated with atypical antipsychotic agents is underperformed. A 1998–2003 study in a Medicaid cohort revealed that fewer than 10 % of adult patients starting therapy with a second-generation antipsychotic had had baseline lipid determinations. Children and adolescents were even less likely to be tested.5 STABLE Performance Measure and Rationale for Measurement of Lipids Measure Percentage of patients diagnosed with bipolar disorder and treated with an atypical antipsychotic agent who received at least one assessment for hyperlipidemia within the initial 16-week period of treatmen