Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, the Netherlands.
Usher Institute, University of Edinburgh, Edinburgh, UK.
Diabetologia. 2024 Jun;67(6):1029-1039. doi: 10.1007/s00125-024-06111-w. Epub 2024 Feb 26.
AIMS/HYPOTHESIS: The aim of this study was to compare cardiovascular risk management among people with type 2 diabetes according to severe mental illness (SMI) status.
We used linked electronic data to perform a retrospective cohort study of adults diagnosed with type 2 diabetes in Scotland between 2004 and 2020, ascertaining their history of SMI from hospital admission records. We compared total cholesterol, systolic BP and HbA target level achievement 1 year after diabetes diagnosis, and receipt of a statin prescription at diagnosis and 1 year thereafter, by SMI status using logistic regression, adjusting for sociodemographic factors and clinical history.
We included 291,644 individuals with type 2 diabetes, of whom 1.0% had schizophrenia, 0.5% had bipolar disorder and 3.3% had major depression. People with SMI were less likely to achieve cholesterol targets, although this difference did not reach statistical significance for all disorders. However, people with SMI were more likely to achieve systolic BP targets compared to those without SMI, with effect estimates being largest for schizophrenia (men: adjusted OR 1.72; 95% CI 1.49, 1.98; women: OR 1.64; 95% CI 1.38, 1.96). HbA target achievement differed by SMI disorder and sex. Among people without previous CVD, statin prescribing was similar or better in those with vs those without SMI at diabetes diagnosis and 1 year later. In people with prior CVD, SMI was associated with lower odds of statin prescribing at diabetes diagnosis (schizophrenia: OR 0.54; 95% CI 0.43, 0.68, bipolar disorder: OR 0.75; 95% CI 0.56, 1.01, major depression: OR 0.92; 95% CI 0.83, 1.01), with this difference generally persisting 1 year later.
CONCLUSIONS/INTERPRETATION: We found disparities in cholesterol target achievement and statin prescribing by SMI status. This reinforces the importance of clinical review of statin prescribing for secondary prevention of CVD, particularly among people with SMI.
目的/假设：本研究的目的是比较 2 型糖尿病患者根据严重精神疾病（SMI）状况进行心血管风险管理的情况。
我们使用链接电子数据对 2004 年至 2020 年间苏格兰被诊断为 2 型糖尿病的成年人进行了回顾性队列研究，通过住院记录确定他们 SMI 的病史。我们使用逻辑回归比较了糖尿病诊断后 1 年内总胆固醇、收缩压和 HbA 目标水平的达标情况，以及诊断时和 1 年后他汀类药物的处方情况，并根据 SMI 状况进行了调整，包括社会人口统计学因素和临床病史。
我们纳入了 291644 名 2 型糖尿病患者，其中 1.0%患有精神分裂症，0.5%患有双相情感障碍，3.3%患有重度抑郁症。患有 SMI 的患者达到胆固醇目标的可能性较低，但所有疾病的差异均未达到统计学意义。然而，与没有 SMI 的患者相比，患有 SMI 的患者更有可能达到收缩压目标，其中精神分裂症的效果估计最大（男性：调整后的 OR 1.72；95%CI 1.49，1.98；女性：OR 1.64；95%CI 1.38，1.96）。HbA 目标的实现因 SMI 障碍和性别而异。在没有既往 CVD 的人群中，在糖尿病诊断时和 1 年后，与没有 SMI 的患者相比，有 SMI 的患者的他汀类药物处方相似或更好。在有既往 CVD 的人群中，SMI 与糖尿病诊断时他汀类药物处方的可能性降低相关（精神分裂症：OR 0.54；95%CI 0.43，0.68，双相情感障碍：OR 0.75；95%CI 0.56，1.01，重度抑郁症：OR 0.92；95%CI 0.83，1.01），这种差异通常在 1 年后仍然存在。
结论/解释：我们发现 SMI 状况与胆固醇目标的实现和他汀类药物的处方存在差异。这再次强调了临床审查他汀类药物用于 CVD 二级预防的重要性，特别是在患有 SMI 的人群中。
