Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States.
Schizophr Bull. 2024 Apr 30;50(3):653-662. doi: 10.1093/schbul/sbad122.
Serious mental illness (SMI) may compromise diabetes self-management. This study assessed the association between SMI and glycemic control, and explored sociodemographic predictors and geographic clustering of this outcome among patients with and without SMI.
We used electronic health record data for adult primary care patients with diabetes from 2 San Francisco health care delivery systems. The primary outcome was poor glycemic control (hemoglobin A1c >9.0%), which was modeled on SMI diagnosis status and sociodemographics. Geospatial analyses examined hotspots of poor glycemic control and neighborhood characteristics.
The study included 11 694 participants with diabetes, 21% with comorbid SMI, of whom 22% had a schizophrenia spectrum or bipolar disorder. Median age was 62 years; 52% were female and 79% were Asian, Black, or Hispanic. In adjusted models, having schizophrenia spectrum disorder or bipolar disorder was associated with greater risk for poor glycemic control (vs participants without SMI, adjusted relative risk [aRR] = 1.24; 95% confidence interval, 1.02, 1.49), but having broadly defined SMI was not. People with and without SMI had similar sociodemographic correlates of poor glycemic control including younger versus older age, Hispanic versus non-Hispanic White race/ethnicity, and English versus Chinese language preference. Hotspots for poor glycemic control were found in neighborhoods with more lower-income, Hispanic, and Black residents.
Poor diabetes control was significantly related to having a schizophrenia spectrum or bipolar disorder, and to sociodemographic factors and neighborhood. Community-based mental health clinics in hotspots could be targets for implementation of diabetes management services.
严重精神疾病（SMI）可能会影响糖尿病的自我管理。本研究评估了 SMI 与血糖控制之间的关系，并探讨了伴有和不伴有 SMI 的患者中这种结果的社会人口学预测因素和地理聚集性。
我们使用了来自两个旧金山医疗服务系统的成年初级保健患者的电子健康记录数据，这些患者患有糖尿病。主要结局是血糖控制不佳（糖化血红蛋白>9.0%），其模型基于 SMI 诊断状态和社会人口统计学因素。地理空间分析检查了血糖控制不佳的热点和邻里特征。
这项研究包括了 11694 名患有糖尿病的参与者，其中 21%患有合并 SMI，其中 22%患有精神分裂症谱系或双相情感障碍。中位数年龄为 62 岁；52%为女性，79%为亚洲人、黑人和西班牙裔。在调整后的模型中，患有精神分裂症谱系障碍或双相情感障碍与血糖控制不佳的风险增加相关（与没有 SMI 的参与者相比，调整后的相对风险 [aRR] = 1.24；95%置信区间，1.02~1.49），但广义定义的 SMI 则不然。患有和不患有 SMI 的患者血糖控制不佳的社会人口学相关因素相似，包括年龄较小与较大、西班牙裔与非西班牙裔白种人、英语与中文偏好。血糖控制不佳的热点出现在低收入、西班牙裔和黑人居民较多的社区。
糖尿病控制不佳与患有精神分裂症谱系或双相情感障碍以及社会人口学因素和邻里环境显著相关。在热点地区的社区心理健康诊所可以成为实施糖尿病管理服务的目标。
