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Erschienen in: Journal of General Internal Medicine 1/2018

31.10.2017

Diabetes Screening among Antipsychotic-Treated Adults with Severe Mental Illness in an Integrated Delivery System: A Retrospective Cohort Study

verfasst von: Christina Mangurian, MD, Dean Schillinger, MD, John W. Newcomer, MD, Eric Vittinghoff, PhD, Susan Essock, PhD, Zheng Zhu, MS, Wendy Dyer, MS, Julie Schmittdiel, PhD

Erschienen in: Journal of General Internal Medicine | Ausgabe 1/2018

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Abstract

Background

Severe mental illness (SMI) is associated with increased risk for type 2 diabetes, partly due to adverse metabolic effects of antipsychotic medications. In public health care settings, annual screening rates are 30%. We measured adherence to national diabetes screening guidelines for patients taking antipsychotic medications.

Objective

To estimate diabetes screening prevalence among patients with SMI within an integrated health care system, and to assess characteristics associated with lack of screening.

Design

Retrospective cohort study.

Participants

Antipsychotic-treated adults with SMI. We excluded participants with known diabetes.

Main Measures

Primary outcome was screening via fasting glucose test or hemoglobin A1c during a 1-year period.

Key Results

In 2014, 16,754 patients with SMI diagnoses were receiving antipsychotics. Seventy-four percent of these patients’ providers ordered diabetes screening tests that year, but only 55% (9247/16,754) received screening. When the observation time frame was extended to 2 years, 73% (12,250/16,754) were screened. Adjusting for sex and race/ethnicity, young adults (aged 18–29 years) were less likely to receive screening than older age groups [adjusted RR (aRR) 1.23–1.57, p < 0.0001]. Compared to whites, screening was more common for Asians (aRR 1.141, 95% CI 1.089–1.195, p < 0.0001), less common for blacks (aRR 0.946, 95% CI 0.898–0.997, p < 0.0375), and no different for Hispanics (aRR 1.030, 95% CI 0.988–1.074, p = 0.165). Smokers were less likely to be screened than non-smokers (aRR 0.93, 95% CI 0.89–0.97, p < 0.0008). Utilization of either mental health or primary care services increased the likelihood of screening.

Conclusions

While almost three-fourths of adults with SMI taking antipsychotic medications received a lab order for diabetes screening, only 55% received screening within a 12-month period. Young adults and smokers were less likely to be screened, despite their disproportionate metabolic risk. Future studies should assess the barriers and facilitators with regard to diabetes screening in this vulnerable population at the patient, provider, and system levels.
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Metadaten
Titel
Diabetes Screening among Antipsychotic-Treated Adults with Severe Mental Illness in an Integrated Delivery System: A Retrospective Cohort Study
verfasst von
Christina Mangurian, MD
Dean Schillinger, MD
John W. Newcomer, MD
Eric Vittinghoff, PhD
Susan Essock, PhD
Zheng Zhu, MS
Wendy Dyer, MS
Julie Schmittdiel, PhD
Publikationsdatum
31.10.2017
Verlag
Springer US
Erschienen in
Journal of General Internal Medicine / Ausgabe 1/2018
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-017-4205-9

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