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Researchers highlight gaps in diabetes screening in patients on antipsychotics

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Integration of mental, physical health needed

The higher risk for premature death in those with serious mental illness also is affected by poor access to health care.

“To improve care for persons with serious mental illness, it will be necessary to break down the silos that separate the mental health and physical health care systems,” wrote Dr. Mitchell H. Katz. This research highlights the need for improved integrated health care for those with mental illness.

Dr. Katz is the deputy editor of JAMA Internal Medicine and director of the Los Angeles County Department of Health Services. He reported no conflicts of interest. These remarks were made in an editorial accompanying Dr. Mangurian’s research letter.


 

FROM JAMA INTERNAL MEDICINE

References

Less than one-third of patients with severe mental illness who are on antipsychotic medications receive diabetes-specific screening, according to a new study.

Severe mental illness (SMI) and antipsychotics place patients at risk for type 2 diabetes. Premature cardiovascular disease is a major contributor to the 25-year lower life expectancy in those with severe mental illness.

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Dr. Christina Mangurian of the department of psychiatry at the University of California, San Francisco, and her colleagues looked at the prevalence of diabetes screening in patients with severe mental illness on antipsychotic medications. Their results were published Nov. 9 in a research letter in JAMA Internal Medicine online.

They conducted a retrospective cohort study using data from the Client and Service Information Systems, and California Medicaid during two study periods. The cohort included patients 18 years or older with severe mental illness diagnosed by a psychiatrist and use of antipsychotic medications during the study periods. The primary outcome was evidence of fasting serum glucose screening or glycated hemoglobin with a secondary outcome of a nonspecific screening, such as a nonfasting metabolic panel.

The cohort was made up of 50,915 participants, and 30.1% (n = 15,315) had a diabetes-specific screening test. No glucose screening during the studied year was found in nearly a third, or 31.1%, (n = 15,832) of the participants.

Interestingly, those with at least one primary care visit during the study period received diabetes-specific screening 35.8% of the time, compared with 19.6% of the time for those without a primary care visit.

“In this large cohort study of adults with SMI taking antipsychotic medications in the California public mental health care system, almost 70% were not screened for diabetes mellitus using validated screening measures,” the authors wrote. They emphasized the need for future studies to better understand barriers to screening in patients with SMI.

Dr. Mangurian reported no disclosures. Dr. Penelope K. Knapp, one of the authors, reported serving as medical director of the California Department of Mental Health. Dr. John W. Newcomer, another author, reported serving on several data safety monitoring boards for pharmaceutical companies and receiving honoraria from multiple sources. The authors reported multiple funding sources.

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