Despite High Risk, Many Adults With Mental Illness Not Screened for Diabetes

Despite a recommendation by the American Diabetes Association for annual screening of patients treated with antipsychotic medications, a new study found that many patients in the California public mental healthcare system who have severe mental illness and are taking antipsychotic medications were not being screened. The study was published online as a Research Letter in JAMA Internal Medicine.

All participants in the study were aged 18 years or older, were diagnosed with severe mental illness by a psychiatrist, and prescribed antipsychotic medications at least once during the study period. All patients were enrolled in California Medicaid (Medi-Cal) and were non-dual eligible for Medicare.

Christina Mangurian, MD, of the University of California, San Francisco, and colleagues used data from the Medi-Cal and Client and Service Information systems for the year 2009 and from October 2010 through September 2011 to perform the retrospective cohort study. Diabetes screenings were performed with either a glucose-specific fasting blood test or a glycated hemoglobin test.

Of 50,915 study participants, 30.1% received diabetes-specific screenings. Approximately 39% of participants underwent nonspecific diabetes screening (glucose-specific nonfasting blood test) and 31% of participants had no glucose screening.

“Almost 70% were not screened for diabetes mellitus using validated screening measures,” the investigators noted.

Having at least one outpatient primary care visit during the study period was the strongest factor affecting whether diabetes-specific screening was performed, the study found, leading the researchers to conclude that their observation supports the value of “burgeoning efforts to integrate behavioral health and primary care.”

Adults with severe mental illness such as schizophrenia and bipolar disorder are estimated to die 25 years earlier than the general population, largely because of premature cardiovascular disease. Severe mental illness is associated with higher risk of type 2 diabetes. Treatment with antipsychotic medications contributes to this elevated risk, with most evidence focused on second-generation antipsychotic medications; similar increases in risk are reported with older and newer medications.

The authors recommend that future studies should explore barriers to screening in this vulnerable population.