Knudsen Lenette, Scheuer Stine H, Diaz Lars J, Jackson Caroline A, Wild Sarah H, Benros Michael E, Hansen Dorte L, Jørgensen Marit E, Andersen Gregers S
Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark.
Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
Lancet Reg Health Eur. 2022 Dec 16;26:100565. doi: 10.1016/j.lanepe.2022.100565. eCollection 2023 Mar.
This study aims to examine quality of diabetes care in persons with type 2 diabetes with and without severe mental illness (SMI).
In a nationwide prospective register-based study, we followed persons with type 2 diabetes in Denmark with and without SMI including schizophrenia, bipolar disorder, or major depression. Quality of care was measured as receipt of care (hemoglobin A1c, low-density lipoprotein-cholesterol and urine albumin creatinine ratio assessment and eye and foot screening) and achievement of treatment targets between 2015 and 2019. Quality of care was compared in persons with and without SMI using generalized linear mixed models adjusted for key confounders.
We included 216,537 persons with type 2 diabetes. At entry 16,874 (8%) had SMI. SMI was associated with lower odds of receiving care, with the most pronounced difference in urine albumin creatinine ratio assessment and eye screening (OR: 0.55, 95% CI: 0.53-0.58 and OR: 0.37 95% CI: 0.32-0.42, respectively). Among those with an assessment, we found that SMI was associated with higher achievement of recommended hemoglobin A1c levels and lower achievement of recommended low-density lipoprotein-cholesterol levels. Achievement of recommended low-density lipoprotein-cholesterol levels was similar in persons with versus without schizophrenia.
Compared to persons without SMI, persons with SMI were less likely to receive process of care, with the most pronounced differences in urine albumin creatinine ratio assessment and eye screening.
This study was funded by Steno Diabetes Center Copenhagen through an unrestricted grant from Novo Nordisk Foundation.
本研究旨在调查伴有和不伴有严重精神疾病（SMI）的2型糖尿病患者的糖尿病护理质量。
在一项全国性的基于前瞻性登记的研究中，我们对丹麦患有和未患有SMI（包括精神分裂症、双相情感障碍或重度抑郁症）的2型糖尿病患者进行了随访。护理质量通过接受护理情况（糖化血红蛋白、低密度脂蛋白胆固醇和尿白蛋白肌酐比值评估以及眼部和足部筛查）以及2015年至2019年期间治疗目标的达成情况来衡量。使用针对关键混杂因素进行调整的广义线性混合模型，对伴有和不伴有SMI的患者的护理质量进行了比较。
我们纳入了216,537名2型糖尿病患者。在入组时，16,874人（8%）患有SMI。SMI与接受护理的几率较低相关，在尿白蛋白肌酐比值评估和眼部筛查方面差异最为显著（比值比分别为：0.55，95%置信区间：0.53 - 0.58；0.37，95%置信区间：0.32 - 0.42）。在接受评估的患者中，我们发现SMI与推荐的糖化血红蛋白水平较高达成率以及推荐的低密度脂蛋白胆固醇水平较低达成率相关。患有精神分裂症的患者与未患精神分裂症的患者在推荐的低密度脂蛋白胆固醇水平达成率方面相似。
与不伴有SMI的患者相比，伴有SMI的患者接受护理流程的可能性较小，在尿白蛋白肌酐比值评估和眼部筛查方面差异最为显著。
本研究由哥本哈根斯滕诺糖尿病中心通过诺和诺德基金会的无限制赠款资助。
