Haupt Dan W, Rosenblatt Lisa C, Kim Edward, Baker Ross A, Whitehead Richard, Newcomer John W
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110-1093, USA.
Am J Psychiatry. 2009 Mar;166(3):345-53. doi: 10.1176/appi.ajp.2008.08030383. Epub 2009 Jan 15.
The authors sought to quantify plasma lipid and glucose testing rates in patients receiving second-generation antipsychotics before and after guidelines recommending testing were issued in February 2004 by the American Diabetes Association (ADA).
In this retrospective cohort analysis using data from a large managed care database (PharMetrics, 2000-2006), patients under age 65 on second-generation antipsychotics were identified and followed from 40 days before to 130 days after the antipsychotic prescription was written. Baseline and 12-week (40 days) lipid and glucose testing rates were determined for pre- and postguideline cohorts. Logistic regression analyses determined predictors of baseline and 12-week lipid and glucose testing while controlling for covariates.
A total of 5,787 preguideline patients and 17,832 postguideline patients were identified. Baseline lipid testing rates were 8.4% for the preguideline cohort and 10.5% for the postguideline cohort, and the 12-week testing rates were 6.8% and 9.0%, respectively. Baseline glucose testing rates were 17.3% for the preguideline cohort and 21.8% for the postguideline cohort, and the 12-week testing rates were 14.1% and 17.9%, respectively. All four comparisons were statistically significant. Baseline and 12-week testing rates for lipids and glucose in children were the lowest of all age groups.
Despite statistically significant improvements after the ADA guidelines were issued, monitoring for plasma lipids and glucose in this population remains low. Clinicians and administrators responsible for the health of at-risk populations should implement new approaches for effective monitoring of major modifiable risk factors for medical morbidity and mortality in patients taking second-generation antipsychotics.
作者试图对在2004年2月美国糖尿病协会（ADA）发布建议检测的指南前后，接受第二代抗精神病药物治疗的患者的血浆脂质和血糖检测率进行量化。
在这项回顾性队列分析中，使用来自一个大型管理式医疗数据库（PharMetrics，2000 - 2006年）的数据，识别出年龄在65岁以下且正在服用第二代抗精神病药物的患者，并在开具抗精神病药物处方前40天至开具处方后130天对其进行随访。确定指南发布前和发布后队列的基线及12周（40天）脂质和血糖检测率。在控制协变量的同时，通过逻辑回归分析确定基线及12周脂质和血糖检测的预测因素。
共识别出5787名指南发布前的患者和17832名指南发布后的患者。指南发布前队列的基线脂质检测率为8.4%，指南发布后队列为10.5%，12周检测率分别为6.8%和9.0%。指南发布前队列的基线血糖检测率为17.3%，指南发布后队列为21.8%，12周检测率分别为14.1%和17.9%。所有这四项比较均具有统计学意义。儿童的脂质和血糖基线及12周检测率在所有年龄组中是最低的。
尽管ADA指南发布后检测率有统计学意义上的显著提高，但该人群的血浆脂质和血糖监测率仍然较低。负责高危人群健康的临床医生和管理人员应采用新方法，对服用第二代抗精神病药物患者的主要可改变的发病和死亡风险因素进行有效监测。
