Cardiometabolic management in severe mental illness requiring an atypical antipsychotic

Abstract

Introduction: Cardiometabolic management was evaluated in patients with diabetes and a severe mental illness that require treatment with an atypical antipsychotic.

Methods: Seventy-four patients with diabetes and a severe mental illness treated with an atypical antipsychotic from the Fargo Veterans' Affairs Health Care System were included in this retrospective study. Primary end points analyzed the change in hemoglobin A1c (Hgb A1c), blood pressure, and low-density lipoprotein (LDL) cholesterol 12 months prior to and 12 months following the initiation of an atypical antipsychotic. Secondary end points evaluated changes specific to clozapine and olanzapine. Additional secondary end points evaluated the medication management for cardiometabolic disease prior to and following atypical antipsychotic initiation.

Results: In the 12 months following atypical antipsychotic initiation, there were no statistically significant changes in metabolic parameters. Mean Hgb A1c increased from 6.9% to 7.2% (P = .47), mean systolic blood pressure decreased slightly from 132 to 127.8 mm Hg (P = .97), mean diastolic blood pressure decreased slightly from 79.6 to 76.6 mm Hg (P = .19), and mean LDL remained unchanged at 104.4 mg/dL (P = .92). Medications to control cardiometabolic disease increased substantially following atypical antipsychotic initiation; 35.1%, 39.2%, and 39.2% of patients were started on one or more new antihyperglycemics, antihypertensives, and statins, respectively.

Discussion: Patients had a significant increase in prescriptions to manage cardiometabolic disease in the 12 months following initiation of an atypical antipsychotic. Although medications to manage cardiometabolic disease increased, the actual metabolic parameters did not significantly change during the same time period.

Keywords: atypical antipsychotics; diabetes; psychotic disorders; schizophrenia.