This measure assesses the percentage of members 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic monitoring. Three rates are reported:
- The percentage of children and adolescents on antipsychotics who received blood glucose testing.
- The percentage of children and adolescents on antipsychotics who received cholesterol testing.
- The percentage of children and adolescents on antipsychotics who received blood glucose and cholesterol testing.
Why It Matters?
Antipsychotic medications offer the potential for effective treatment of psychiatric disorders in children; however, they can also increase a child’s risk for developing serious health concerns, including metabolic health complications. Antipsychotic medications are associated with several potentially adverse impacts, including weight gain1 and diabetes.2,3
A multi-year study of youth enrolled in three HMOs found that exposure to atypical antipsychotics was associated with a fourfold risk of diabetes in the following year, compared to children not prescribed a psychotropic medication, the broader class of medications under which antipsychotics fall.3 Another study of youth enrolled in a state Medicaid plan found that those starting an antipsychotic had three times the risk of developing diabetes, compared to youth starting other psychotropic medications.3 The association of atypical antipsychotics with diabetes has been found to be greater among children and adolescents than among adults.4,5
Research suggests that metabolic problems in childhood and adolescence are associated with poor cardiometabolic outcomes in adulthood.6 The long-term consequences of pediatric obesity and other metabolic disturbances include higher risk of heart disease in adulthood.7 Due to the potential negative health consequences associated with children developing cardiometabolic side effects from an antipsychotic medication, it is important to both establish a baseline and continuously monitor metabolic indices to ensure appropriate management of side-effects.
The American Academy of Child and Adolescent Psychiatry guidelines recommend metabolic monitoring, including monitoring of glucose and cholesterol levels, for children and adolescents on antipsychotic medications.8
*Developed with financial support from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) under CHIPRA Pediatric Quality Measures Program Centers of Excellence grant number U18HS020503.
Historical Results – National Averages
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Blood Glucose Testing (Total)
| Measurement Year | Commercial HMO | Commercial PPO | Medicaid HMO |
|---|---|---|---|
| 2023 | 56 | 56.3 | 56.6 |
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Cholesterol Testing (Total)
| Measurement Year | Commercial HMO | Commercial PPO | Medicaid HMO |
|---|---|---|---|
| 2023 | 38.2 | 37.6 | 39.1 |
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Blood Glucose and Cholesterol Testing (Total)
| Measurement Year | Commercial HMO | Commercial PPO | Medicaid HMO |
|---|---|---|---|
| 2023 | 36.2 | 35.9 | 37.6 |
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- Correll, C.U. 2008. “Antipsychotic Use in Children and Adolescents: Minimizing Adverse Effects to Maximize Outcomes.” FOCUS: The Journal of Lifelong Learning in Psychiatry 6(3):368–78.
- Andrade, S.E., J.C. Lo, D. Roblin, et al. December 2011. “Antipsychotic Medication Use Among Children and Risk of Diabetes Mellitus.” Pediatrics 128(6):1135–41.
- Bobo, W.V., W.O. Cooper, C.M. Stein, et al. October 1, 2013. “Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth.” JAMA Psychiatry 70(10):1067–75.
- Hammerman, A., J. Dreiher, S.H. Klang, H. Munitz, A.D. Cohen, M. Goldfracht. September 2008. “Antipsychotics and Diabetes: An Age-Related Association.” Annals of Pharmacotherapy 2(9):1316–22.
- Holt, R.I.G. September 2, 2019. “Association Between Antipsychotic Medication Use and Diabetes.” Curr Diab Rep 19(10):96. Doi: 10.1007/s11892-019-1220-8. PMID: 31478094; PMCID: PMC6718373. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718373/#CR23
- Srinivasan, S.R., L. Myers, G.S. Berenson. January 2002. “Predictability of Childhood Adiposity and Insulin for Developing Insulin Resistance Syndrome (Syndrome X) in Young Adulthood: the Bogalusa Heart Study.” Diabetes 51(1):204–9.
- Baker, J., L. Olesen, T. Sorensen. 2007. “Childhood Body Mass Index and the Risk of Coronary Heart Disease in Adulthood.” New England Journal of Medicine 357:2329–37.
- American Academy of Child and Adolescent Psychiatry. 2011. Practice Parameters for the Use of Atypical Antipsychotic Medications in Children and Adolescents. https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_Web.pdf (August 2, 2011)
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