Measure:

Bipolar Disorder: Monitoring for weight gain

Summary:

This measure assesses the percentage of patients with bipolar disorder who were monitored for weight gain during initial 12 week period of treatment.

Clinical Rationale:

General Population Issues; Overweight and Obesity

• Data from the National Center for Health Statistics show that 30% of U.S. adults 20 years of age and older—over 60 million—people are obese 

Metabolic Effects Associated with Overweight or Obese Conditions

• Increases in adiposity, particularly visceral abdominal fat, are associated with decreases in insulin sensitivity in individuals both with and without psychiatric disease (1)
• Increasing prevalence rates of overweight or obese individuals raise concerns regarding the risks of many health conditions associated with insulin resistance, including hyperglycemia and hyperlipidemia leading to Type 2 diabetes and/or cardiovascular disease (2)

Bipolar Disorder and Weight Gain

• The estimated prevalence of obesity in persons with bipolar disorder ranges from 13.0-49.0 percent in various studies; with an unknown percentage attributable to lifestyle-related issues associated with the condition (3,4)
• Treatment with pharmacotherapy associated with bipolar disorder, particularly the various antipsychotics, has been associated with an additional increase in weight ranging from less than 2 lbs up to 10 lbs (5)

Denominator Population:

Patients diagnosed with bipolar disorder

Data Sources:

• Administrative data
• Medical Record

Numerator Population:

Patients who have had actual weight documented twice within the initial 12 weeks of treatment

Data Source:

• Medical Record

Initial Case-finding Guidance:

Patients with a diagnosis involving bipolar disorder
ICD9CM or DSM IV TR: 296.0x; 296.1x; 296.4x; 296.5x; 296.6x; 296.7; 296.80-82; 296.89; or 301.13

STABLE Resource Toolkit:

The STABLE National Coordinating Council has recommended metabolic monitoring when treating with antipsychotic agents.  The following documentation tool is available in the corresponding section of the STABLE Resource Toolkit..

• Metabolic Monitoring Flow Sheet:  Brief documentation tool for office-based practice

References:

1. Newcomer, JW, Medical Risk in Patients with Bipolar Disorder and Schizophrenia; J Clin Psychiatry 2006; 67 (Suppl 9) 25-30
2. American Diabetes Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27:596-601
3. Fagiolini A, Frank E, Scott JA, et al. Metabolic syndrome in bipolar disorder, findings from the Bipolar Disorder Center for Pennsylvanians. Bipolar Disord 2005;7;424-430
4. McElroy SL, Frye MA, Suppes T, et al. Correlates of overweight and obesity in 644 patients with bipolar disorder. J Clin Psychiatry 2002; 63:207-213
5. Newcomer JW, Haupt DW, The Metabolic Effects of Antipsychotic Medications, Can J Psychiatry, Vol 51, No 8, July 2006; 480-491