Endocrine Abstracts

Background: Higher prevalence of type 2 Diabetes Mellitus (DM II) has been reported in patients with SMI (serious mental illness). SMI patients get suboptimal diabetes care as compare to non- SMI patients.

Methods: We tested the hypothesis that SMI patients get suboptimal diabetes care as compare to non- SMI patients. We did a retrospective cohort study in an academic, primary care clinic for underserved,urban population.SMI patients included schizophrenia and bipolar disorder diagnosed by psychiatrist. We created electronic database of variables of interest for eligible patient population. Inclusion criteria included patients ages 18–75, and have been seen by a primary care provider for at least 1 year with at least 2 visits and at least 2 HbA1c levels between the study period. 184 SMI patients met the inclusion criteria; and were compared to 184 patients of non-SMI patients. Patients being treated by an endocrinologist for DMII were excluded from the study. Outcomes measures including HbA1c, blood pressure, LDL, eye and foot exam, nephropathy assessment and smoking status; and process measures such as alcohol and substance abuse, medications, pneumonia vaccine and health care utilization measures were measured and compared between two groups.

Results: Data analysis was done using logistic regression. After controlling for possible confounders such as gender, Race, BMI and Insulin use, there was no significant difference in HbA1C control of <7 between SMI and non-SMI groups (P=0.115). Patients who were on insulin therapy were less likely to achieve HbA1c < 7 without any significant difference between SMI and non-SMI groups (12.5% vs 11.8%). However SMI patients who were not on insulin were more likely than non-SMI patients to achieve HbA1C < 7 (75.3% vs 63.2%, OR =3.26, 95% CI: 2.05–5.19, P <0.001). No significant between group difference was observed in remaining parameters of nephropathy assessment, blood pressure, foot exam, smoking cessation treatment offered except for eye exam (OR =1.90, 95% CI: 1.08–3.34; P=0.027). There was no significant difference in above parameters after adjusting for Antipsychotics use. There was no significant difference between the groups for number of clinic visits or continuity of primary care provided.

Conclusion: Diabetes care of SMI patients is not suboptimal to non- SMI patients in primary care clinic. Further study is needed to evaluate whether living in a supervised group home facility of SMI patients contributes improved care of SMI patients observed in our clinic.