Many patients in the California public mental health care system with severe mental illness, such as schizophrenia and bipolar disorder, who were taking antipsychotic medications were not screened for diabetes despite a recommendation for annual screening, according to an article published online by JAMA Internal Medicine.
Adults with severe mental illness are estimated to die, on average, 25 years earlier than the general population, largely because of premature cardiovascular disease. Severe mental illness is associated with elevated risk for type 2 diabetes and treatment with antipsychotic medications contributes to this risk. The American Diabetes Association recommends annual screening for patients treated with antipsychotic medications.
Christina Mangurian, M.D., of the University of California, San Francisco, and colleagues analyzed data from the California Medicaid (Medi-Cal) and Client and Service Information systems for two periods: the year 2009 and from October 2010 through September 2011. The authors reviewed diabetes screening either with a glucose-specific fasting blood test or a glycated hemoglobin test.
The authors report that of 50,915 study participants, 30.1 percent of participants (n=15,315) received diabetes-specific screening. The strongest factor affecting diabetes-specific screening was having at least one outpatient primary care visit during the study period. About 39 percent of the participants (n=19,768) underwent nonspecific diabetes screening (defined by a glucose-specific nonfasting blood test), while 31 percent of participants (n=15,832) had no glucose screening, according to study results data.
"This observation supports the value of burgeoning efforts to integrate behavioral health and primary care. Growing evidence supports the value of screening for diabetes mellitus in higher-risk populations, such as those receiving treatment with antipsychotic medications, including first-generation and second-generation agents that commonly result in co-occurring obesity. Future studies should explore barriers to screening in this vulnerable population," the authors conclude.
Editor's Note: Improving the Health of Persons with Serious Mental Illness
In a related editor's note, Mitchell H. Katz, M.D., a deputy editor of JAMA Internal Medicine and director of the Los Angeles County Department of Health Services, writes: "To improve care for persons with serious mental illness, it will be necessary to break down the silos that separate the mental health and physical health care systems."