What is the HEDIS (Healthcare Effectiveness Data and Information Set) measure for monitoring glucose levels or Hemoglobin A1c (HbA1c) in adults taking antipsychotics?

HEDIS Measure for Glucose/A1c Monitoring in Adults Taking Antipsychotics

The HEDIS measure for monitoring glucose level or A1c in adults taking antipsychotics requires screening at baseline (before starting medication), again 12-16 weeks after medication initiation, and annually thereafter. 1

Background and Importance

Second-generation antipsychotic medications significantly increase the risk of type 2 diabetes and metabolic disorders. This risk varies across medications:

• Higher metabolic risk: clozapine, olanzapine, quetiapine
• Medium metabolic risk: risperidone
• Lower metabolic risk: aripiprazole, ziprasidone, haloperidol 1, 2

Specific HEDIS Monitoring Requirements

Timing of Monitoring

1. Baseline screening: Before starting antipsychotic medication
2. Follow-up screening: 12-16 weeks after medication initiation
3. Ongoing monitoring: At least annually thereafter 1

Testing Parameters

• Primary test: Hemoglobin A1c or fasting glucose test
• Additional recommended monitoring: Weight/BMI and lipid panel 3, 4

Implementation Challenges

Despite these clear guidelines, monitoring rates remain suboptimal:

• Only 55% of patients receive appropriate glucose screening within a 12-month period 5
• Monitoring is more likely to occur at baseline than at follow-up 3
• Young adults (18-29 years) are less likely to be screened despite their metabolic risk 5

Risk Stratification

Certain patient populations require more vigilant monitoring:

• Patients with existing diabetes or dyslipidemia
• Patients on high-risk antipsychotics (clozapine, olanzapine)
• Patients with additional risk factors:
  • Obesity (BMI ≥24 kg/m²)
  • Age ≥40 years
  • Family history of diabetes
  • Certain racial/ethnic groups (higher risk in non-white populations) 1

Clinical Pearls and Pitfalls

1. A1c limitations: In some cases, A1c may underestimate glycemia in certain populations. Consider fructosamine or CGM when A1c results don't align with clinical presentation 1

2. Common monitoring gaps:

   • Patients without a psychiatric diagnosis are less likely to be monitored than those with schizophrenia 3
   • Smokers are less likely to be screened despite increased metabolic risk 5

3. Prediabetes detection: Patients on antipsychotics may have A1c in the prediabetic range (5.7-6.4%) even with normal fasting glucose, making A1c monitoring particularly important 6

By adhering to these HEDIS monitoring guidelines, clinicians can identify metabolic complications early, potentially reducing morbidity and mortality associated with diabetes in this vulnerable population.