Second-generation antipsychotics (SGAs) increase risk for glucose intolerance in adults; less is known about risk in youth. MOBILITY is a large, multi-center, pragmatic study designed to assess the effect of metformin added to a lifestyle intervention compared to lifestyle alone on weight gain and metabolic parameters in overweight and obese pediatric (ages 8-19) patients with bipolar-spectrum disorders (BSD) receiving SGAs. Frank diabetes was an exclusion criterion. It was recommended to obtain baseline, +6 month, and +12 month fasting metabolic labs in this trial conducted in real-world psychiatry clinics. We estimated prevalence of glucose intolerance prior to intervention. We hypothesized that youth with elevated fasting plasma glucose (FPG) and hemoglobin A1C (HbA1C) would be more likely to have repeat metabolic assessment. Altogether, 684 youth (mean age=14.3 years, 53% male, 64% with baseline BMI ≥95th%ile) were included in these analyses. Baseline FPG was obtained in 73% (501/684); 12.1% of these had impaired fasting glucose (IFG). Baseline HbA1C was obtained in 53% (360/684); 11.1% had HbA1C ≥5.7%. Six patients (1.6%) had both measures elevated. Only 41% of patients with IFG and 40% of those with HbA1C ≥5.7% had repeat glucose measures within 1 year; neither were more likely to have repeat laboratory testing than patients with normal baseline laboratory results (OR=0.88, p=0.773; OR=0.85; p=1.00, respectively). Of six patients with both IFG and HbA1C elevated at baseline, only three had repeat laboratory testing; one of these developed diabetes on follow-up. Overweight and obese youth with BSD on SGA therapy have clinically relevant rates of glucose intolerance. However, assessment and, especially, reassessment of abnormal glucose status in this population is poor. Further studies are needed to identify and address barriers for evaluation for glucose intolerance in this at-risk population.
N.A. Crimmins: None. M.P. DelBello: None. C. Correll: Consultant; Self; Alkermes plc., Allergan plc., Janssen Pharmaceuticals, Inc., Lundbeck, Otsuka Pharmaceutical Co., Ltd., Pfizer Inc., Sumitomo Dainippon Pharma Co., Ltd., Sunovion Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited, Teva Pharmaceutical Industries Ltd. C. Klein: None. T. Blom: None. J. Welge: None.
Patient-Centered Outcomes Research Institute (to M.P.D.)