Study explores diabetes screening for patients with severe mental illness

A study just published in the Journal of the American Medical Association Internal Medicine examines diabetes screening for patients with severe mental illness, who are two to three times more likely to have type 2 diabetes than the general population. More than seven million Americans in the United States have severe mental illness, and there are many factors contributing to their increased risk of getting diabetes, including treatment with antipsychotic medication.

John W. Newcomer, M.D., co-author of the study and executive vice dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University, notes that the findings from this study support ongoing efforts to integrate mental health services and primary care to improve diagnosis and treatment in this patient population.

"On average, adults in the U.S. with severe mental illnesses such as schizophrenia and bipolar disorder die nearly 25 years earlier than the general population due largely to premature cardiovascular disease," said Newcomer. "Unrecognized and undertreated risk factors like elevated cholesterol, hypertension, hyperglycemia, obesity and smoking can all contribute to risk. In addition, some psychiatric medications can cause or contribute to weight gain and risk for metabolic problems like insulin resistance and diabetes."

The study examined people with Medicaid in California and is one of the first to examine diabetes screening in this high-risk population served in community mental health clinics. Results of the study revealed that low-income patients on Medicaid are infrequently screened for diabetes. The American Diabetes Association and American Psychiatric Association both recommend that providers do at least annual diabetes screening for any patients taking antipsychotic medications, but growing evidence indicates that screenings typically occur much less frequently.

The new study examined diabetes screenings in a cohort of 50,915 publically insured adults with severe mental illness who were taking antipsychotic medication. The researchers found that more than 70 percent did not receive a diabetes screening test. However, those who had at least one primary care visit in addition to mental health services were twice as likely to be screened.

The researchers retrospectively identified 50,915 adults diagnosed with serious mental illness who were prescribed antipsychotic medication during two study periods: Jan. 1, 2009 through Dec. 31, 2009 and Oct. 1, 2010 through Sept. 1, 2011. They examined medical records to determine whether patients received diabetes-specific screening, non-specific screening or no screening. Approximately 30 percent received a diabetes-specific screening and around 30 percent received no medical tests at all.

"Growing evidence suggests that integrated care systems, involving both primary care as well as psychiatric medical care, for patients with mental illness can better serve the complicated health care needs of mentally ill patients who often have medical health issues as well as psychiatric problems," said Newcomer. "At this time, patients' mental health electronic records are often completely separate from their primary care electronic health record. Further, patients often can't see their psychiatrist and their primary care doctor on the same day in the same place, complicating arrangements to align all needed elements of care - all this in a patient population where complexity can be a big barrier to successful care."