Morrato Elaine H, Nicol Ginger E, Maahs David, Druss Benjamin G, Hartung Daniel M, Valuck Robert J, Campagna Elizabeth, Newcomer John W
Department of Health Systems, Management,and Policy, Colorado School of Public Health, University of Colorado at Denver, Aurora, Colorado 80045, USA.
Arch Pediatr Adolesc Med. 2010 Apr;164(4):344-51. doi: 10.1001/archpediatrics.2010.48.
To estimate metabolic screening rates, predictors of screening, and incidence of metabolic disturbances in children initiating second-generation antipsychotic (SGA) drug treatment.
A retrospective, new-user cohort study (between July 1, 2004, and June 30, 2006) using Medicaid claims data.
California, Missouri, and Oregon.
A total of 5370 children (aged 6-17 years) without diabetes mellitus taking SGA drugs and 15,000 children without diabetes taking albuterol (control individuals) [corrected] but no SGA drugs.
Findings 1 year after recommendations from the American Diabetes Association and American Psychiatric Association called for metabolic screening of patients receiving SGA drugs.
Serum glucose and lipid testing, 6-month incidence of diabetes, and dyslipidemia disturbances.
Glucose screening was performed in 1699 (31.6% [95% confidence interval (CI), 30.4%-32.9%]) SGA-treated children vs 1891 (12.6% [12.1%-13.2%]) control individuals. Lipid testing was performed in 720 (13.4% [95% CI, 12.5%-14.4%]) SGA-treated children vs 458 (3.1% [2.8%-3.3%]) controls. In multivariate logistic regression analysis, children with serious and/or multiple psychiatric diagnoses and those who used health care services more intensively were more likely to receive metabolic screening. The case incidence of glucose and lipid disorders was higher in SGA-treated vs albuterol-treated children (8.9 per 1000 children [95% CI, 6.6%-11.8%] vs 4.9 per 1000 children [3.9%-6.2%]; and 9.7 per 1000 children [95% CI, 7.2%-12.7%] vs 4.6 per 1000 children [95% CI, 3.6%-5.8%], respectively).
Most children starting treatment with SGA medications in this public sector sample did not receive recommended glucose and lipid screening.
评估开始接受第二代抗精神病药物（SGA）治疗的儿童的代谢筛查率、筛查预测因素以及代谢紊乱的发生率。
一项回顾性新用户队列研究（2004年7月1日至2006年6月30日），使用医疗补助索赔数据。
加利福尼亚州、密苏里州和俄勒冈州。
共有5370名6至17岁未患糖尿病且正在服用SGA药物的儿童，以及15000名未患糖尿病且正在使用沙丁胺醇（对照个体）[已校正]但未服用SGA药物的儿童。
在美国糖尿病协会和美国精神病学协会建议对接受SGA药物治疗的患者进行代谢筛查1年后的研究结果。
血糖和血脂检测、糖尿病6个月发病率以及血脂异常紊乱情况。
1699名（31.6%[95%置信区间（CI），30.4%-32.9%]）接受SGA治疗的儿童进行了血糖筛查，而对照个体为1891名（12.6%[12.1%-13.2%]）。720名（13.4%[95%CI，12.5%-14.4%]）接受SGA治疗的儿童进行了血脂检测，而对照组为458名（3.1%[2.8%-3.3%]）。在多因素逻辑回归分析中，患有严重和/或多种精神疾病诊断的儿童以及使用医疗服务更频繁的儿童更有可能接受代谢筛查。接受SGA治疗的儿童中葡萄糖和脂质紊乱的病例发生率高于接受沙丁胺醇治疗的儿童（每1000名儿童中8.9例[95%CI，6.6%-11.8%]对每1000名儿童中4.9例[3.9%-6.2%]；以及每1000名儿童中9.7例[95%CI，7.2%-12.7%]对每1000名儿童中4.6例[95%CI，3.6%-5.8%]）。
在这个公共部门样本中，大多数开始使用SGA药物治疗的儿童未接受推荐的血糖和血脂筛查。
