People with diabetes, severe mental illness have better CV risk factor management

Takeaway

• People with diabetes mellitus (DM) who have comorbid severe mental illness (SMI) have better control of major cardiovascular (CV) risk factors than those without SMI.
• However, smoking cessation and retinopathy screening lag with SMI.

Why this matters

• Diabetes prevalence among people with SMI is more than twice that of the general population.

Study design

• Retrospective study of electronic health records for 269,243 adults with diabetes, including 4399 with comorbid SMI.
• Funding: NIH.

Key results

• Analyses were controlled for age, sex, race, urban area, BMI, primary care use, and medical facility.
• Adjusted relative risk (aRR) for HbA1c <7% with vs without SMI: 1.25 (P<.001).
  • Mean adjusted HbA1c: 7.16% vs 7.47% (P<.001).
• For systolic BP (SBP) <140 mmHg:
  • aRR with vs without SMI: 1.03 (P<.001).
  • Mean SBP: 125 vs 128 mmHg (P<.001).
• For low-density lipoprotein cholesterol (LDL-C) <100 mg/dL:
  • aRR with vs without SMI: 1.02 (P=.044). 
  • Mean adjusted LDL-C: 85 vs 88 mg/dL (P<.001).
• SMI group was less likely to quit smoking (aRR, 0.94; P=.001) or have retinopathy screening (aRR, 0.80; P<.001).

Limitations

• Data from 1 health system, may not be generalisable.
• No data on exposure to antipsychotics that raise diabetes risk.
• Smoking status unknown for 8%-14%.