1 Department of Psychiatry, University of Toronto , Toronto, Canada .
2 Institute for Clinical Evaluative Sciences , Toronto, Canada .
J Womens Health (Larchmt). 2018 Mar;27(3):290-296. doi: 10.1089/jwh.2017.6490. Epub 2017 Dec 6.
Diabetes is common among individuals with chronic psychotic illness, yet they receive lower quality of diabetes care than those without psychosis. Men usually receive higher quality diabetes care than women, but whether this holds true in chronic psychotic illness populations is unknown. We aimed to determine whether quality of diabetes care differs between men and women with chronic psychotic illness.
This population-based cohort study used Ontario health administrative data to compare women and men with comorbid chronic psychotic illness and diabetes mellitus (2011-2013). The primary outcome was adherence to diabetes monitoring guidelines, defined as ≥1 retinal exam, ≥4 hemoglobin A1c (HbA1c) tests, and ≥1 dyslipidemia test during a 2-year period. Logistic regression models compared women to men to generate adjusted odds ratios (aOR) and confidence intervals (95% CI), adjusting for potential confounding variables.
Women with chronic psychotic illness (n = 13,972) were slightly more likely to receive guideline-adherent diabetes monitoring than men (n = 12,287) (25.2% vs. 23.0%; aOR 1.20, 95% CI 1.10-1.30), including a greater likelihood of receiving ≥1 retinal exam (aOR 1.13, 95% CI 1.08-1.19) and ≥4 HbA1c tests (aOR 1.06, 95% CI 1.01-1.12). There was no difference in receipt of ≥1 dyslipidemia test (aOR 1.04, 95% CI 0.99-1.11).
Quality of diabetes monitoring is similarly poor in women and men with chronic psychotic illness, with women receiving only marginally more optimal monitoring than men. This differs from patterns in the general population, and could have implications when designing and implementing interventions to improve diabetes care in women and men with chronic psychotic illness.
糖尿病在患有慢性精神病的个体中很常见，但他们接受的糖尿病护理质量低于没有精神病的个体。男性通常比女性接受更高质量的糖尿病护理，但这种情况在慢性精神病患者中是否成立尚不清楚。我们旨在确定慢性精神病患者中男性和女性的糖尿病护理质量是否存在差异。
这项基于人群的队列研究使用安大略省的健康管理数据，比较了 2011 年至 2013 年期间患有合并慢性精神病和糖尿病的男性和女性。主要结局是遵守糖尿病监测指南的情况，定义为在 2 年内进行≥1 次视网膜检查、≥4 次糖化血红蛋白（HbA1c）检测和≥1 次血脂检测。使用逻辑回归模型比较女性与男性，以生成调整后的优势比（aOR）和置信区间（95%CI），并调整潜在的混杂变量。
患有慢性精神病的女性（n=13972）比男性（n=12287）更有可能接受符合指南的糖尿病监测（25.2%对 23.0%；aOR 1.20，95%CI 1.10-1.30），包括更有可能进行≥1 次视网膜检查（aOR 1.13，95%CI 1.08-1.19）和≥4 次 HbA1c 检测（aOR 1.06，95%CI 1.01-1.12）。在接受≥1 次血脂检测方面，差异无统计学意义（aOR 1.04，95%CI 0.99-1.11）。
患有慢性精神病的女性和男性的糖尿病监测质量同样较差，女性仅比男性接受略多的最佳监测。这与一般人群的模式不同，在设计和实施干预措施以改善患有慢性精神病的女性和男性的糖尿病护理时，可能会产生影响。
