Department of Psychiatry, University of California San Francisco (UCSF) Weill Institute of Neurosciences, San Francisco, CA, USA.
UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
J Gen Intern Med. 2018 Jan;33(1):79-86. doi: 10.1007/s11606-017-4205-9. Epub 2017 Oct 31.
Severe mental illness (SMI) is associated with increased risk for type 2 diabetes, partly due to adverse metabolic effects of antipsychotic medications. In public health care settings, annual screening rates are 30%. We measured adherence to national diabetes screening guidelines for patients taking antipsychotic medications.
To estimate diabetes screening prevalence among patients with SMI within an integrated health care system, and to assess characteristics associated with lack of screening.
Retrospective cohort study.
Antipsychotic-treated adults with SMI. We excluded participants with known diabetes.
Primary outcome was screening via fasting glucose test or hemoglobin A1c during a 1-year period.
In 2014, 16,754 patients with SMI diagnoses were receiving antipsychotics. Seventy-four percent of these patients' providers ordered diabetes screening tests that year, but only 55% (9247/16,754) received screening. When the observation time frame was extended to 2 years, 73% (12,250/16,754) were screened. Adjusting for sex and race/ethnicity, young adults (aged 18-29 years) were less likely to receive screening than older age groups [adjusted RR (aRR) 1.23-1.57, p < 0.0001]. Compared to whites, screening was more common for Asians (aRR 1.141, 95% CI 1.089-1.195, p < 0.0001), less common for blacks (aRR 0.946, 95% CI 0.898-0.997, p < 0.0375), and no different for Hispanics (aRR 1.030, 95% CI 0.988-1.074, p = 0.165). Smokers were less likely to be screened than non-smokers (aRR 0.93, 95% CI 0.89-0.97, p < 0.0008). Utilization of either mental health or primary care services increased the likelihood of screening.
While almost three-fourths of adults with SMI taking antipsychotic medications received a lab order for diabetes screening, only 55% received screening within a 12-month period. Young adults and smokers were less likely to be screened, despite their disproportionate metabolic risk. Future studies should assess the barriers and facilitators with regard to diabetes screening in this vulnerable population at the patient, provider, and system levels.
严重精神疾病（SMI）与 2 型糖尿病风险增加有关，部分原因是抗精神病药物的代谢不良影响。在公共卫生保健环境中，年度筛查率为 30%。我们衡量了服用抗精神病药物的患者对国家糖尿病筛查指南的依从性。
在综合医疗保健系统内估计患有 SMI 的患者的糖尿病筛查率，并评估与缺乏筛查相关的特征。
回顾性队列研究。
接受抗精神病药物治疗的患有 SMI 的成年人。我们排除了已知患有糖尿病的参与者。
主要结果是在 1 年内通过空腹血糖测试或糖化血红蛋白进行筛查。
2014 年，有 16754 名患有 SMI 诊断的患者正在接受抗精神病药物治疗。这些患者中有 74%的患者的提供者当年开了糖尿病筛查测试，但只有 55%（9247/16754）接受了筛查。当观察时间延长至 2 年时，有 73%（12250/16754）接受了筛查。在调整性别和种族/民族因素后，年轻成年人（18-29 岁）接受筛查的可能性低于年龄较大的人群[调整后的相对危险度（aRR）1.23-1.57，p<0.0001]。与白人相比，亚洲人（aRR 1.141，95%CI 1.089-1.195，p<0.0001）的筛查更为常见，黑人（aRR 0.946，95%CI 0.898-0.997，p<0.0375）的筛查较少，而西班牙裔（aRR 1.030，95%CI 0.988-1.074，p=0.165）则没有差异。吸烟者筛查的可能性低于非吸烟者[aRR 0.93，95%CI 0.89-0.97，p<0.0008]。使用心理健康或初级保健服务增加了筛查的可能性。
尽管近四分之三的服用抗精神病药物的 SMI 成年人接受了实验室开具的糖尿病筛查医嘱，但在 12 个月内只有 55%接受了筛查。尽管年轻成年人和吸烟者的代谢风险更高，但他们接受筛查的可能性较低。未来的研究应该在患者、提供者和系统层面评估针对这一弱势群体的糖尿病筛查的障碍和促进因素。
