Abstract
OBJECTIVE: Annual monitoring of metabolic control is recommended for patients with type 2 diabetes (T2D) prescribed second-generation antipsychotics (SGA), with uncertain validity as a performance measure for health plans. To study the rates of metabolic monitoring and control in the three years after antipsychotic prescription following T2D diagnosis. METHODS: We used the electronic health record data from Epic Cosmos. We identified adult patients (n = 469,503) with newly diagnosed T2D between 2012 and 2021 as those who were prescribed SGA (6.9%), first-generation antipsychotics (FGA) (4.4%), or neither (88.7%). Rates of metabolic monitoring (weight, HbA1c, LDL, and estimated glomerular filtration rate using CKD-EPI 2021 [eGFR]) and control (HbA1c ≤8%, blood pressure ≤140/90 mmHg, and LDL ≤100 mg/dL) in the three years after first prescription of SGA, FGA or neither were modeled used logistic generalized estimating equations. RESULTS: The sample was 52% female, 17% non-Hispanic Black, and 6.7% Hispanic; mean age was 63.8 years (SD: 13.1). In Year 1, relative to those prescribed neither, the adjusted rates of monitoring of weight were similar but HbA1c (Neither: 92.3%[95%CI: 88.4-95.0], SGA: 81.9%[95%CI: 73.4-88.1], FGA: 73.6%[95%CI: 62.6-82.3]) and LDL (Neither: 71.5%[95%CI: 62.5-79.0], SGA: 57.8%[95%CI: 47.0-68.0], FGA: 49.9%[95%CI: 38.7-61.1]) were lower, among those prescribed antipsychotics, with overlapping confidence intervals. eGFR was monitored more frequently among patients prescribed SGA and FGA only in Year 1 (Neither: 66.4%[95%CI: 57.1-74.7], SGA: 76.3%[95%CI: 67.4-83.4], FGA: 82.0%[95%CI: 73.5-88.2]). Rates decreased over time for all groups across all outcomes. Rates of metabolic control were higher than national averages, but similar over time and did not differ between groups. CONCLUSION: Declining rates of metabolic monitoring, independent of antipsychotic prescription, present opportunities for quality improvement initiatives among patients with T2D.