Rathmann Wolfgang, Pscherer Stefan, Konrad Marcel, Kostev Karel
German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.
Clinical Diabetes Center, Traunstein, Germany.
Prim Care Diabetes. 2016 Feb;10(1):36-40. doi: 10.1016/j.pcd.2015.04.001. Epub 2015 Apr 27.
Aim of this study were to compare outcomes (HbA1c, BMI) and antidiabetic treatment of type 2 diabetes patients with and without schizophrenia under real-life conditions in primary care practices in Germany.
1321 type 2 diabetes patients with and 1321 matched controls (age, sex, diabetes duration, diabetologist care, practice) without schizophrenia in 1072 general practices throughout Germany were retrospectively analyzed (Disease Analyser: 01/2009-12/2013). Antidiabetic treatment, HbA1c and BMI were compared using paired t-tests, McNemar tests and conditional logistic regression adjusting for macro- and microvascular comorbidity (ICD-10).
Mean age (±SD) of patients and controls was 67.4±13.2 years (males: 38.9%). Diabetes duration was 5.7±4.3 years, 6% were in diabetologist care. Private health insurance was less often found among patients with schizophrenia than controls (2.2% vs 6.3%; p<0.0001). There was no difference in the mean HbA1c values (cases: 7.1±1.4%; controls: 7.2±1.5%) (54.1 vs. 55.2 mmol/mol) (p=0.8797) and in the average BMI (32.4±6.6 vs. 31.0±5.0 kg/m(2); p=0.2072) between the two groups. Novel cost-intensive antidiabetic agents (DPP-4- or SGLT2-inhibitors, GLP-1 receptor agonists) were less often prescribed in cases (15.3 vs. 18.3%; p=0.0423). However, in multivariable logistic regression, schizophrenia (odds ratio, 95%CI: 1.101; 0.923-1.317) was not associated with prescription use of novel antidiabetic agents (reference: other antidiabetic agents) after adjusting for private health insurance (OR: 2.139; 1.441-3.177) and comorbidity.
There is no evidence that type 2 diabetes patients with schizophrenia have worse diabetes control than those without a severe mental illness in general practices.
本研究旨在比较德国初级医疗实践中，患有和未患有精神分裂症的2型糖尿病患者的治疗效果（糖化血红蛋白、体重指数）及抗糖尿病治疗情况。
对德国1072家普通诊所中的1321例患有2型糖尿病的患者以及1321例匹配的无精神分裂症对照者（年龄、性别、糖尿病病程、糖尿病专家护理、诊所）进行回顾性分析（疾病分析仪：2009年1月至2013年12月）。使用配对t检验、McNemar检验和条件逻辑回归分析比较抗糖尿病治疗、糖化血红蛋白和体重指数，并对大血管和微血管合并症（国际疾病分类第十版）进行校正。
患者和对照者的平均年龄（±标准差）为67.4±13.2岁（男性：38.9%）。糖尿病病程为5.7±4.3年，6%接受糖尿病专家护理。与对照者相比，精神分裂症患者中私人医疗保险的比例更低（2.2%对6.3%；p<0.0001）。两组间糖化血红蛋白的平均水平（病例组：7.1±1.4%；对照组：7.2±1.5%）（54.1对55.2 mmol/mol）（p=0.8797）以及平均体重指数（32.4±6.6对31.0±5.0 kg/m²；p=0.2072）均无差异。新型高成本抗糖尿病药物（二肽基肽酶-4抑制剂或钠-葡萄糖协同转运蛋白2抑制剂、胰高血糖素样肽-1受体激动剂）在病例组中的处方率更低（15.3%对18.3%；p=0.0423）。然而，在多变量逻辑回归分析中，校正私人医疗保险（比值比：2.139；1.441 - 3.177）和合并症后，精神分裂症（比值比，95%置信区间：1.101；0.923 - 1.317）与新型抗糖尿病药物的处方使用无关（参考：其他抗糖尿病药物）。
没有证据表明在普通诊所中，患有精神分裂症的2型糖尿病患者的糖尿病控制情况比没有严重精神疾病的患者更差。
