Comorbid Diabetes and Severe Mental Illness: Outcomes in an Integrated Health Care Delivery System

Abstract

BACKGROUND: Diabetes prevalence is twice as high among people with severe mental illness (SMI) when compared to the general population. Despite high prevalence, care outcomes are not well understood. OBJECTIVE: To compare diabetes health outcomes received by people with and without comorbid SMI, and to understand demographic factors associated with poor diabetes control among those with SMI. DESIGN: Retrospective cohort study PARTICIPANTS: 269,243 adults with diabetes MAIN MEASURES: Primary outcomes included optimal glycemic control (A1c < 7) or poor diabetes control (A1c > 9) in 2014. Secondary outcomes included control of other cardiometabolic risk factors (hypertension, dyslipidemia, smoking) and recommended diabetes monitoring. KEY RESULTS: Among this cohort, people with SMI (N = 4,399), compared to those without SMI (N = 264,844), were more likely to have optimal glycemic control, adjusting for various covariates (adjusted relative risk (aRR) 1.25, 95% CI 1.21-1.28, p < .001) and less likely to have poor control (aRR 0.92, 95% CI 0.87-0.98, p = 0.012). Better blood pressure and lipid control was more prevalent among people with SMI when compared to those without SMI (aRR 1.03; 95% CI 1.02-1.05, p < .001; aRR 1.02; 95% CI 1.00-1.05, p = 0.044, respectively). No differences were observed in recommended A1c or LDL testing, but people with SMI were more likely to have blood pressure checked (aRR 1.02, 95% CI 1.02-1.03, p < .001) and less likely to receive retinopathy screening (aRR 0.80, 95% CI 0.71-0.91, p < .001) than those without SMI. Among people with diabetes and comorbid SMI, younger adults and Hispanics were more likely to have poor diabetes control. CONCLUSIONS: Adults with diabetes and comorbid SMI had better cardiometabolic control than people with diabetes who did not have SMI, despite lower rates of retinopathy screening. Among those with comorbid SMI, younger adults and Hispanics were more vulnerable to poor A1c control.

Breast Cancer Screening in Women With Schizophrenia: A Systematic Review and Meta-Analysis

“…Studies had to meet the following inclusion criteria: report on the primary outcome measure of mammography screening, compare mammography screening rates to a control population of women meeting recommended breast cancer screening guideline criteria, and provide sufficient data to calculate relative-risk or odds ratios (ORs). As previously described, studies were eligible if they included women with a diagnosis of schizophrenia or a related psychotic disorder, such as schizoaffective disorder, as defined by DSM-5 (295.xx), ICD-10 (F20.x, F25.x), or other valid measure (20). We did not aim to analyze studies that reported mammography screening rates for women with mental distress, delirium, dementia, developmental disorders, eating disorders, nonpsychotic mood disorders, or substance use disorders.…”

Impact of Multicomponent Support Strategies on Human Immunodeficiency Virus Virologic Suppression Rates During Coronavirus Disease 2019: An Interrupted Time Series Analysis

“…First, we performed a pre- and post-analysis of the time periods before and after the multicomponent strategies, adjusting for sex at birth, age as a continuous variable, race/ethnicity, housing status assessed at the beginning of SIP (experiencing homelessness/unstable housing vs housed; also assessed at the end of the analysis period), and the presence of severe mental illness based on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) codes [ 21 ], using mixed-effects logistic regression. A random effect was included for the participant over multiple laboratory assessments.…”

Public Stigma Toward Schizophrenia Within Latino Communities in the United States

“…The co-occurrence of schizophrenia and Type II diabetes within Latino communities continues to provide challenges for those seeking to improve their physical and psychological health simultaneously. Recent work by Mangurian et al, 2020 indicates that co-occurrence of diabetes and any serious mental illness is higher in Latino communities and is less well controlled. Further complicating this issue and potentially perpetuating stigma in this area is fact that the primary medical treatment for schizophrenia, antipsychotic medication, significantly increases one’s risk of Type II diabetes (Hirsch et al, 2017 ; Neilson et al, 2010 ; Smith et al, 2008 ), potentially discouraging those with untreated psychotic symptoms from seeking care for these symptoms.…”