Comorbid Diabetes and Severe Mental Illness: Outcomes in an Integrated Health Care Delivery System
| العنوان: | Comorbid Diabetes and Severe Mental Illness: Outcomes in an Integrated Health Care Delivery System |
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| المؤلفون: | Eric Vittinghoff, Zheng Zhu, Wendy Dyer, Julie A. Schmittdiel, Christina Mangurian, Dean Schillinger, Kelly C. Young-Wolff, Susan M. Essock, John W. Newcomer |
| المصدر: | J Gen Intern Med |
| بيانات النشر: | Springer Science and Business Media LLC, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Adult, medicine.medical_specialty, education, Population, 01 natural sciences, Article, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Internal medicine, mental disorders, Diabetes Mellitus, Internal Medicine, Humans, Medicine, 030212 general & internal medicine, 0101 mathematics, Retrospective Studies, Glycemic, education.field_of_study, business.industry, Mental Disorders, 010102 general mathematics, Retrospective cohort study, medicine.disease, Blood pressure, Relative risk, Hypertension, Cohort, business, Delivery of Health Care, Dyslipidemia |
| الوصف: | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-05489-3) contains supplementary material, which is available to authorized users. |
| تدمد: | 1525-1497 0884-8734 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8911a4bac10617b8f48714b6214213e9 https://doi.org/10.1007/s11606-019-05489-3 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....8911a4bac10617b8f48714b6214213e9 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 15251497 08848734 |
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