Department of Psychiatry, Universityof Maryland School of Medicine, Baltimore, MD 21201,
Schizophr Bull. 2010 Mar;36(2):428-35. doi: 10.1093/schbul/sbn106. Epub 2008 Aug 20.
Individuals with schizophrenia are at increased risk for poor health outcomes and mortality. This may be due to inadequate self-management of co-occurring conditions, such as type 2 diabetes. We compared adherence to oral hypoglycemic medications for diabetes patients with vs without comorbid schizophrenia. Using Veterans Affairs (VA) health system administrative data, we identified all patients with both schizophrenia and type 2 diabetes and with at least one oral hypoglycemic prescription fill in fiscal year 2002 (N = 11 454) and a comparison group of patients with diabetes who were not diagnosed with schizophrenia (N = 10 560). Nonadherence was operationalized as having a medication possession ratio indicating receipt of less than 80% of needed hypoglycemic medications. Poor adherence was less prevalent among diabetes patients with (43%) than without schizophrenia (52%, P < .001). In multivariable analyses, having schizophrenia was associated with a 25% lower likelihood of poor adherence compared with not having schizophrenia (adjusted odds ratio: 0.75, 95% confidence interval: 0.70-0.80). Poorer adherence was associated with black race, homelessness, depression, substance use disorder, and medical comorbidity. Having more outpatient visits, a higher proportion of prescriptions delivered by mail, lower prescription copayments, and more complex medication regimens were each associated with increased adherence. Among veterans with diabetes receiving ongoing VA care, overall hypoglycemic medication adherence was low, but individuals with comorbid schizophrenia were more likely to be adherent to these medications. Future studies should investigate whether factors such as comanagement of a chronic psychiatric illness or regular contact with mental health providers bestow benefits for diabetes self-management in persons with schizophrenia.
患有精神分裂症的个体发生不良健康结局和死亡的风险增加。这可能是由于合并症（如 2 型糖尿病）的自我管理不足所致。我们比较了伴或不伴共病精神分裂症的糖尿病患者对口服降糖药物的依从性。使用退伍军人事务部 (VA) 医疗系统管理数据，我们确定了所有同时患有精神分裂症和 2 型糖尿病且在 2002 财年至少有一次口服降糖药物处方的患者（N=11454），以及未被诊断为精神分裂症的糖尿病患者（N=10560）的对照组。不依从被定义为药物持有率表明接受的降糖药物不足所需的 80%。患有糖尿病且伴有精神分裂症的患者（43%）比不伴有精神分裂症的患者（52%，P<0.001）更不易发生依从性差。在多变量分析中，与不伴精神分裂症相比，伴精神分裂症与较差的依从性的可能性降低 25%（调整优势比：0.75，95%置信区间：0.70-0.80）。较差的依从性与黑种人、无家可归、抑郁、物质使用障碍和合并症有关。就诊次数较多、通过邮件交付的处方比例较高、处方共付额较低和更复杂的药物治疗方案均与依从性增加相关。在接受 VA 持续护理的患有糖尿病的退伍军人中，总体上降糖药物的依从性较低，但伴有共病精神分裂症的个体更有可能坚持这些药物。未来的研究应探讨是否合并管理慢性精神疾病或定期与精神卫生提供者接触等因素能为精神分裂症患者的糖尿病自我管理带来益处。
