Christina Mangurian1,2, Dean Schillinger3,4, John W Newcomer5, Eric Vittinghoff6, Susan Essock7, Zheng Zhu8, Wendy Dyer8, Kelly C Young-Wolff9,8, Julie Schmittdiel8. 1. Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, USA. christina.mangurian@ucsf.edu. 2. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. christina.mangurian@ucsf.edu. 3. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. 4. UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. 5. Thriving Mind South Florida and Washington University School of Medicine, St Louis, CA, USA. 6. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. 7. Department of Psychiatry, Columbia University, New York City, NY, USA. 8. Kaiser Permanente Northern California Division of Research, Oakland, CA, USA. 9. Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
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.
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.
Entities:
Keywords:
diabetes; health outcomes; healthcare delivery system; severe mental illness
Authors: Sarah L Krein; C Raymond Bingham; John F McCarthy; Allison Mitchinson; Jonathan Payes; Marcia Valenstein Journal: Psychiatr Serv Date: 2006-07 Impact factor: 3.084
Authors: Susan M Frayne; Jewell H Halanych; Donald R Miller; Fei Wang; Hai Lin; Leonard Pogach; Erica J Sharkansky; Terence M Keane; Katherine M Skinner; Craig S Rosen; Dan R Berlowitz Journal: Arch Intern Med Date: 2005 Dec 12-26
Authors: Julie Kreyenbuhl; Faith B Dickerson; Deborah R Medoff; Clayton H Brown; Richard W Goldberg; Lijuan Fang; Karen Wohlheiter; Leena P Mittal; Lisa B Dixon Journal: J Nerv Ment Dis Date: 2006-06 Impact factor: 2.254
Authors: Paul Gorczynski; Joseph Firth; Brendon Stubbs; Simon Rosenbaum; Davy Vancampfort Journal: Psychiatry Res Date: 2017-01-21 Impact factor: 3.222
Authors: Julie Kreyenbuhl; Jaclyn Leith; Deborah R Medoff; Lijuan Fang; Faith B Dickerson; Clayton H Brown; Richard W Goldberg; Wendy Potts; Lisa B Dixon Journal: Psychiatry Res Date: 2011-04-02 Impact factor: 3.222
Authors: Judith A Long; Andrew Wang; Elina L Medvedeva; Susan V Eisen; Adam J Gordon; Julie Kreyenbuhl; Steven C Marcus Journal: Diabetes Care Date: 2014-05-30 Impact factor: 19.112
Authors: David P J Osborn; Christine A Wright; Gus Levy; Michael B King; Raman Deo; Irwin Nazareth Journal: BMC Psychiatry Date: 2008-09-25 Impact factor: 3.630
Authors: Christina V Mangurian; Dean Schillinger; John W Newcomer; Eric Vittinghoff; Susan M Essock; Zheng Zhu; Wendy T Dyer; Julie A Schmittdiel Journal: Diabetes Care Date: 2018-06-13 Impact factor: 19.112
Authors: Matthew L Goldman; Christina Mangurian; Tom Corbeil; Melanie M Wall; Fei Tang; Morgan Haselden; Susan M Essock; Eric Frimpong; Franco Mascayano; Marleen Radigan; Matthew Schneider; Rui Wang; Lisa B Dixon; Mark Olfson; Thomas E Smith Journal: Gen Hosp Psychiatry Date: 2020-06-23 Impact factor: 3.238
Authors: Matthew A Spinelli; Noelle Le Tourneau; David V Glidden; Ling Hsu; Matthew D Hickey; Elizabeth Imbert; Mireya Arreguin; Jennifer P Jain; Jon J Oskarsson; Susan P Buchbinder; Mallory O Johnson; Diane Havlir; Katerina A Christopoulos; Monica Gandhi Journal: Clin Infect Dis Date: 2022-08-24 Impact factor: 20.999
Authors: Alison R Hwong; Julie Schmittdiel; Dean Schillinger; John W Newcomer; Susan Essock; Zheng Zhu; Wendy Dyer; Kelly C Young-Wolff; Christina Mangurian Journal: Addict Behav Date: 2020-10-14 Impact factor: 3.913