2773-LB: Prediabetes Screening and Metformin Use among Adults Taking Antipsychotic Medications in Primary Care

Introduction and Objective: Antipsychotic medications are associated with substantial metabolic risk, including insulin resistance and progression to type 2 diabetes. Early identification of prediabetes may reduce long-term cardiometabolic complications, yet real-world screening and treatment practices remain unclear. The objective of this study was to evaluate diabetes screening and metformin prescribing among adults taking antipsychotic medications in primary care. Methods: This retrospective cohort study used electronic health record data from adult patients empaneled to Family Medicine clinics within a Midwestern health system from 2021 to 2023. Adults with an active antipsychotic prescription and no prior diabetes or metformin use were included. Diabetes screening was defined as fasting glucose and/or hemoglobin A1c testing within 1 year of a qualifying visit. Metformin prescriptions within 1 year were identified. Screening and prescribing patterns were summarized descriptively, and metformin use was compared across diabetes status categories using chi-square testing. Results: The cohort included 8,240 adults taking antipsychotic medications. Within 1 year, 27% underwent diabetes-related laboratory testing. Among those tested, 31.7% met criteria for prediabetes and 8.6% for diabetes. Metformin was prescribed to 4.4% of patients overall. New metformin use increased by diabetes status, occurring in 6.2% of patients with normal results, 12.5% with prediabetes, and 38.5% with diabetes (p < 0.0001). Family Medicine clinicians accounted for most screening tests and metformin prescriptions. Conclusion: Diabetes screening and metformin use were uncommon among adults taking antipsychotic medications in primary care, despite a high prevalence of prediabetes. These findings highlight gaps in early metabolic risk management and support the need for standardized screening, interdisciplinary collaboration, and decision support to improve metabolic outcomes in this high-risk population. Disclosure B.T. Burroughs: None. E. O'Dowd: None. T. Rajjo: None. G.M. Garrison: None. T. Thacher: Consultant; Current; Alexion Pharmaceuticals, Inc., BioMarin Pharmaceutical Inc., Ultragenyx. Funding Mayo Clinic Department of Family Medicine