Indicators of quality of diabetes care in persons with type 2 diabetes with and without severe mental illness: a Danish nationwide register-based cohort study

Knudsen, Lenette; Scheuer, Stine H.; Díaz, Lars Jorge; Jackson, Caroline; Wild, Sarah; Benros, Michael E.; Hansen, Dorte L.; Jørgensen, Marit E.; Andersen, Gregers

doi:10.1016/j.lanepe.2022.100565

Cited by 4 publications

(14 citation statements)

References 32 publications

(101 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other registry studies that have studied T2D treatment in patients with SMI concur that the achievement of treatment targets varies depending on the biochemical parameter evaluated. 10,18,39,40 For example, a study assessed the LDL-C and HbA 1c levels of people with mental illnesses within the first 4 years after a diabetes diagnosis and revealed suboptimal HbA 1c control, but similar LDL-C concentrations compared to people without mental disorders. 39 We also found that fewer people with schizophrenia disorders had low eGFR.…”

Section: Poor Biochemical Risk Factor Controlmentioning

confidence: 99%

“…[2][3][4][5] Many risk factors, including an unhealthy lifestyle, diagnostic overshadowing, psychotropic medications adverse effects, delayed somatic diagnosis, 6,7 and possibly inadequate management of somatic comorbidities, contribute to this disparity. [8][9][10] Health disparities exist even in countries with universal health care, such as Denmark. 11 In Denmark, most T2D patients are treated in general practice, whereas diabetes clinics only manage complicated cases.…”

Section: Introductionmentioning

confidence: 99%

“…13 Despite this, most research on T2D treatment for individuals with SMI has focused on hospital settings 14,15 or has identified people with T2D based on diabetes databases, which do not distinguish between primary and secondary healthcare sectors. 10,16,17 Studies have found conflicting results regarding the quality of T2D treatment for people with SMI, likely due to heterogeneity in methodologies. 10,14,[18][19][20][21][22][23] The treatment of T2D has changed in the last two decades (Figure 1), so the timing of these studies may also account for their varying findings.…”

Section: Introductionmentioning

confidence: 99%

“…10,16,17 Studies have found conflicting results regarding the quality of T2D treatment for people with SMI, likely due to heterogeneity in methodologies. 10,14,[18][19][20][21][22][23] The treatment of T2D has changed in the last two decades (Figure 1), so the timing of these studies may also account for their varying findings. Until the end of the 1990s, glycemic control was the focus of T2D treatment.…”

Section: Introductionmentioning

confidence: 99%

“…People with severe mental illness (SMI) have a lower life expectancy than the general population 1 partly due to a high prevalence of type 2 diabetes (T2D) and cardiovascular diseases 2–5 . Many risk factors, including an unhealthy lifestyle, diagnostic overshadowing, psychotropic medications adverse effects, delayed somatic diagnosis, 6,7 and possibly inadequate management of somatic comorbidities, contribute to this disparity 8–10 . Health disparities exist even in countries with universal health care, such as Denmark 11…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The development of type 2 diabetes management in people with severe mental illness in the Capital Region of Denmark from 2001 to 2015

Bakkedal,

Persson,

Christensen

et al. 2024

Acta Psychiatr Scand

View full text Add to dashboard Cite

BackgroundType 2 diabetes (T2D) treatment has changed markedly within the last decades. We aimed to explore whether people with severe mental illness (SMI) have followed the same changes in T2D treatment as those without SMI, as multiple studies suggest that people with SMI receive suboptimal care for somatic disorders.MethodsIn this registry‐based annual cohort study, we explored the T2D treatment from 2001 to 2015 provided in general practices of the Greater Copenhagen area. We stratified the T2D cohorts by their pre‐existing SMI status. T2D was defined based on elevated glycated hemoglobin (≥48 mmol/mol) or glucose (≥11 mmol/L) using data from the Copenhagen Primary Care Laboratory Database. Individuals with schizophrenia spectrum disorders (ICD‐10 F20–29) or affective disorders (bipolar disorder or unipolar depression, ICD‐10 F30–33) were identified based on hospital‐acquired diagnoses made within 5 years before January 1 each year for people with prevalent T2D or 5 years before meeting our T2D definition for incident patients. For comparison, we defined a non‐SMI group, including people who did not have a hospital‐acquired diagnosis of schizophrenia spectrum disorders, affective disorders, or personality disorders. For each calendar year, we assembled cohorts of people with T2D with or without SMI. We used Poisson regression to calculate the rates per 100 person‐years of having at least one biochemical test (glycated hemoglobin, low‐density lipoprotein cholesterol, estimated glomerular filtration rate, and urine albumin‐creatinine ratio), having poor control of these biochemical results, taking glucose‐lowering or cardiovascular medications, or experiencing a clinical outcome, including all‐cause mortality and cardiovascular mortality. Three outcomes (cardiovascular events, cardiovascular mortality, and all‐cause mortality) were additionally examined and adjusted for age and sex in a post hoc analysis.ResultsFrom 2001 to 2015, 66,914 individuals were identified as having T2D. In 2015, 1.5% of the study population had schizophrenia spectrum disorder and 1.4% had an affective disorder. The number of people who used biochemical tests or had poor biochemical risk factor control was essentially unrelated to SMI status. One exception was that fewer LDL cholesterol tests were done on people with affective disorders and schizophrenia spectrum disorders at the beginning of the study period compared to people in the non‐SMI group. This difference gradually diminished and was almost nonexistent by 2011. There was also a slightly slower rise in UACR test rates in the SMI groups compared to other people with T2D during the period. Throughout the study period, all groups changed their use of medications in similar ways: more metformin, less sulfonylurea, more lipid‐lowering drugs, and more ACEi/ARBs. However, people with schizophrenia disorder consistently used fewer cardiovascular medications. Cardiovascular events were more common in the affective disorder group compared to the non‐SMI group from 2009 to 2015 (rate ratio 2015: 1.36 [95% CI 1.18–1.57]). After adjustment for age and sex, all‐cause mortality was significantly higher among people with a schizophrenia spectrum disorder each year from 2003 to 2015 compared to the non‐SMI group (rate ratio 2015: 1.99 [95% CI 1.26–3.12]).ConclusionPersons with schizophrenia or affective disorders demonstrated the same treatment changes for T2D as those without SMI in general practice. The lower use of most types of cardiovascular medications among people with schizophrenia disorders indicates potential undertreatment of hypertension and dyslipidemia and remains throughout the study period. Cardiovascular events were most common among people with affective disorders, but this was not reflected in a higher proportion using cardiovascular preventive medications. This knowledge should be considered in the management of this vulnerable patient group.

show abstract

Section: Poor Biochemical Risk Factor Controlmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The development of type 2 diabetes management in people with severe mental illness in the Capital Region of Denmark from 2001 to 2015

Bakkedal,

Persson,

Christensen

et al. 2024

Acta Psychiatr Scand

View full text Add to dashboard Cite

show abstract

Cardiovascular risk management among individuals with type 2 diabetes and severe mental illness: a cohort study

ter Braake,

Fleetwood,

Vos

et al. 2024

Diabetologia

Self Cite

View full text Add to dashboard Cite

Aims/hypothesis The aim of this study was to compare cardiovascular risk management among people with type 2 diabetes according to severe mental illness (SMI) status. Methods We used linked electronic data to perform a retrospective cohort study of adults diagnosed with type 2 diabetes in Scotland between 2004 and 2020, ascertaining their history of SMI from hospital admission records. We compared total cholesterol, systolic BP and HbA1c target level achievement 1 year after diabetes diagnosis, and receipt of a statin prescription at diagnosis and 1 year thereafter, by SMI status using logistic regression, adjusting for sociodemographic factors and clinical history. Results We included 291,644 individuals with type 2 diabetes, of whom 1.0% had schizophrenia, 0.5% had bipolar disorder and 3.3% had major depression. People with SMI were less likely to achieve cholesterol targets, although this difference did not reach statistical significance for all disorders. However, people with SMI were more likely to achieve systolic BP targets compared to those without SMI, with effect estimates being largest for schizophrenia (men: adjusted OR 1.72; 95% CI 1.49, 1.98; women: OR 1.64; 95% CI 1.38, 1.96). HbA1c target achievement differed by SMI disorder and sex. Among people without previous CVD, statin prescribing was similar or better in those with vs those without SMI at diabetes diagnosis and 1 year later. In people with prior CVD, SMI was associated with lower odds of statin prescribing at diabetes diagnosis (schizophrenia: OR 0.54; 95% CI 0.43, 0.68, bipolar disorder: OR 0.75; 95% CI 0.56, 1.01, major depression: OR 0.92; 95% CI 0.83, 1.01), with this difference generally persisting 1 year later. Conclusions/interpretation We found disparities in cholesterol target achievement and statin prescribing by SMI status. This reinforces the importance of clinical review of statin prescribing for secondary prevention of CVD, particularly among people with SMI. Graphical Abstract

show abstract

Severe Mental Illness and Type 2 Diabetes Outcomes and Complications: A Nationwide Cohort Study

et al. 2023

Self Cite

View full text Add to dashboard Cite

OBJECTIVE To compare cardiovascular and mortality outcomes in people with severe mental illness (SMI) versus no mental illness in a national cohort study of people with type 2 diabetes. RESEARCH DESIGN AND METHODS We included adults diagnosed with type 2 diabetes between 2004 and 2018 from the national Scottish diabetes register, ascertaining history of mental illness from linked psychiatric and general hospital admission records. We identified major cardiovascular disease (CVD) events, all-cause mortality, and CVD-specific mortality through record linkage. Using Cox regression, we estimated hazard ratios (HRs) for associations between SMI and outcomes, adjusting for baseline sociodemographic and clinical characteristics, including history of CVD, comorbidity, hypertension, high cholesterol, HbA1c, BMI, alcohol use disorder, and smoking. RESULTS Among 259,875 people with type 2 diabetes, 1.0%, 0.5%, and 3.0% had schizophrenia, bipolar disorder, and major depression, respectively. After adjusting for sociodemographic characteristics, the risk of major CVD events was higher in people with schizophrenia (HR 1.22, 95% CI 1.06–1.41), bipolar disorder (HR 1.58, 95% CI 1.33–1.87), and major depression (HR 1.59, 95% CI 1.49–1.70) compared with people without a history of mental illness. SMI was also associated with an approximately twofold increased risk of CVD-specific and all-cause mortality. All associations attenuated following further adjustment for clinical characteristics. CONCLUSIONS Among people with diabetes, people with a history of SMI have poorer cardiovascular and mortality outcomes compared with those without mental illness. While the underlying mechanisms are further investigated, effective prevention and management of cardiovascular risk factors is needed in this high-risk group.

show abstract

Indicators of quality of diabetes care in persons with type 2 diabetes with and without severe mental illness: a Danish nationwide register-based cohort study

Cited by 4 publications

References 32 publications

The development of type 2 diabetes management in people with severe mental illness in the Capital Region of Denmark from 2001 to 2015

The development of type 2 diabetes management in people with severe mental illness in the Capital Region of Denmark from 2001 to 2015

Cardiovascular risk management among individuals with type 2 diabetes and severe mental illness: a cohort study

Severe Mental Illness and Type 2 Diabetes Outcomes and Complications: A Nationwide Cohort Study

Contact Info

Product

Resources

About