Regular accuchecks for patients on atypical antipsychotics?

[dbabz]

Hello all, I'm back with another question. I very much appreciate all of your input as I navigate the waters of neophyte psych nursing.

I've been doing some research into atypical antipsychotics and have learned about glucose dysregulation as a side effect. In addition, it's my understanding that schizophrenia in itself increases risk of type II diabetes (maybe due to concomitant lifestyle characteristics.) I'm noticing that some of my patients are prescribed metformin, but the majority are not.

Here is the question: Do your patients have regularly scheduled accuchecks for your patients on atypicals? If so, how often? I know that I can't order them, but wondering if I should find a diplomatic way to bring it up with the docs.

Thanks in advance.

[verene, MSN]

ADA and APA both recommend fasting glucose checks on initiation, 12 weeks thereafter, and then annually for patients on atypicals. The providers I work with are more likely to get a Hg A1c at initiation to assess baseline risk, and then at 3months and then annually.

[dbabz]

Thanks. Does this include patients on metformin?

And, I'd agree, A1c more appropriate if only done @ three month mark and annually.

[verene, MSN]

I believe so, but haven't checked the guidelines recently. I know providers I work with will test patients on metformin, and will sometimes prescribe metformin prophylactically for patients on atypicals whose values are higher side of normal.

[umbdude, MSN, APRN]

On 4/28/2019 at 11:40 AM, dbabz said:

Here is the question: Do your patients have regularly scheduled accuchecks for your patients on atypicals? If so, how often?

No. I work at a CSU and we only monitor blood glucose if a patient has diabetes. If a patient's DM is well controlled and he/she doesn't need insulin, we don't even check BG regularly.

It is the prescriber's responsibility to monitor for weight gain & insulin resistance of those using atypicals. Generally they get a baseline when starting an atypical, recheck in 3 months, then annually.

Only a few atypicals have significant effect on weight gain & insulin resistance (ie, olanzapine, clozapine, and less so with quetiapine); and even if they're on one of these, not all of them will develop insulin resistance with weight gain. Furthermore, adding on another med (ie, metformin) to fix a side effect is really a last resort and generally not a good practice. I actually rarely see this done.

[PsychMD]

On 4/28/2019 at 2:17 PM, verene said:

ADA and APA both recommend fasting glucose checks on initiation, 12 weeks thereafter, and then annually for patients on atypicals. The providers I work with are more likely to get a Hg A1c at initiation to assess baseline risk, and then at 3months and then annually.

Same with lipids and blood pressure. Weight is typically monitored more frequently, and some recommend getting waist circumference annually, but I feel this recommendation probably isn't as often followed.

[dbabz]

Thanks all. Interestingly, I never did mention it, but the medical doc has been ordering b.i.d checks for some of the patients. Haven't had any need for insulin yet.

[TerpGal02, ASN]

No I've not seen routine accuchecks for Pts on atypicals unless of course they are diabetic. Usually what I have seen in tje settings I have worked in is that the prescribers will get an A1C on initiation and then regularly thereafter. I have seen Pts being prescribed Metformin alongside the atypical a couple times before. The rationale prescribers have given me is to help curtail weight gain.

[dbabz]

Thanks!

[TheNietzsche]

On 6/7/2019 at 10:22 PM, TerpGal02 said:

the rationale prescribers have given me is to help curtail weight gain.

Yes exactly, metformin can potentially attenuate the weight gain and insulin resistance often seen in those on atypicals. There's quite a bit of research on this topic in the extant literature.

[K8e]

On 4/28/2019 at 5:17 PM, verene said:

ADA and APA both recommend fasting glucose checks on initiation, 12 weeks thereafter, and then annually for patients on atypicals. The providers I work with are more likely to get a Hg A1c at initiation to assess baseline risk, and then at 3months and then annually.

Same!