Vermont Medicaid/CHIP (CCS-21)
APM: Metabolic Monitoring for Children & Adolescents on Antipsycotics: Blood Glucose & Cholesterol - Age 1-17 (CCS-21)
Current Value
27.6%
Definition
Notes on Methodology
- The target trendline in the graph above represents an accepted national benchmark percentile for Medicaid programs across the country. In 2020 (for measurement year 2019) we modified the value shown to demonstrate a target based on our actual performance. For this measure, the target is the 75th national percentile.
- The annual reported rate captures activity during the previous calendar year.
- This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
Story Behind the Curve
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.
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 gain and diabetes.
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. 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. The association of atypical antipsychotics with diabetes has been found to be greater among children and adolescents than among adults.
Research suggests that metabolic problems in childhood and adolescence are associated with poor cardiometabolic outcomes in adulthood. The long-term consequences of pediatric obesity and other metabolic disturbances include higher risk of heart disease in adulthood. 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.
Last updated: August 2021
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