Quality and Predictors of Diabetes Care Among Patients With Schizophrenia: A Danish Nationwide Study
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
The Danish Clinical Registries
The PCRR
Study Population
Individuals with diabetes.
Individuals with diabetes and schizophrenia.
Predictors of Diabetes Care
Measure | Definitionb |
---|---|
Assessment of psychopathology by a specialist in psychiatry | Incident patients who are assessed for psychopathological characteristics by a psychiatrist or specialist clinical psychologist to ensure a valid diagnosis |
Assessment of psychopathology by interview form | Incident patients who receive a diagnostic interview with an established interview instrument, such as the Schedules for Clinical Assessment in Neuropsychiatry or the Operational Criteria Checklist for Psychotic Illness |
Assessment of cognitive function | Incident patients who are administered cognitive testing by a psychologist |
Assessment by a social worker | Incident patients who are assessed for need for social support by a social worker, for example, financial help to purchase medicine or help with changing housing or applying for disability benefits |
Antipsychotic medical treatment | Patients who are prescribed antipsychotic medical treatment |
Outpatient antipsychotic medical treatment | Outpatients in medical treatment who are receiving more than one antipsychotic |
Benzodiazepine medical treatment | Outpatients in medical treatment with benzodiazepines, exclusive of benzodiazepine-related drugs (zolpidem, zopiclone, and zaleplon) |
Contact with relatives | Staff contact with the patient’s relatives |
Psychoeducation | Patents who receive psychoeducation |
Professional support | Patients with a Global Assessment of Functioning score ≤30 who are referred to postdischarge professional support in their own home, a residential facility, or a care home |
Psychiatric aftercare | Patients who are referred to psychiatric aftercare, including outpatient treatment or contact with a general practitioner or a private specialist after discharge |
Suicide risk assessment | Patients who are assessed for suicide risk at discharge |
Quality of Diabetes Care
Measure | Definition |
---|---|
Glycemic monitoring | Individuals who have their glycated hemoglobin (HbA1c) level monitored at least once a year |
Antidiabetic medication | Individuals with type 2 diabetes with HbA1c ≥53 mmol/mol (7%) who are treated with antidiabetic medication |
Blood pressure monitoring | Individuals who have their blood pressure monitored at least once a year |
Antihypertensive medication | Individuals with a blood pressure of >140/90 mmHg who are treated with antihypertensive medication |
Cholesterol monitoring | Individuals over age 30 who have their low-density lipoprotein (LDL) cholesterol monitored at least once every second year |
Lipid-lowering medication | Individuals with type 2 diabetes over age 40 with LDL cholesterol >2.5 mmol/l who are treated with lipid-lowering medication |
Screening for albuminuria | Individuals who are screened for albuminuria at least once every second year |
ACE/ATII inhibitors medication | Individuals with micro- or macroalbuminuria who are treated with angiotensin-converting enzyme (ACE)/angiotensin II receptor (ATII) inhibitors |
Eye examination I | Individuals receiving an eye examination at least once every second year |
Eye examination II | Individuals receiving an eye examination at least once every fourth year |
Foot examination | Individuals receiving a foot examination at least once every second year |
Statistical Analyses
Results
Diabetes and schizophrenia (N=1,681) | Diabetes only (N=300,957) | |||
---|---|---|---|---|
Characteristic | N | % | N | % |
Sex | ||||
Female | 688 | 41 | 125,016 | 42 |
Male | 993 | 59 | 175,941 | 58 |
Age | ||||
18–39 | 423 | 25 | 43,487 | 15 |
40–44 | 220 | 13 | 22,144 | 7 |
45–49 | 260 | 15 | 25,429 | 8 |
50–54 | 260 | 15 | 30,363 | 10 |
55–59 | 245 | 15 | 35,377 | 12 |
≥60 | 273 | 17 | 144,157 | 48 |
Diabetes type | ||||
Type 1 | 423 | 25 | 117,595 | 39 |
Type 2 | 1,189 | 71 | 174,097 | 58 |
Other types of diabetes and diabetes without specification | 44 | 3 | 6,175 | 2 |
Missing | 25 | 1 | 3,090 | 1 |
HbA1c (mmol/mol) (%) | ||||
9–<46 (3–<6.4) | 260 | 16 | 32,895 | 11 |
46–<53 (6.4–<7) | 216 | 13 | 45,247 | 15 |
53–<64 (7–<8) | 358 | 21 | 90,501 | 30 |
64–<75 (8–<9) | 308 | 18 | 67,335 | 22 |
75–195 (9–20) | 484 | 29 | 58,802 | 20 |
Other (<9 and >195) (<3 and >20) | 1 | <1 | 48 | <1 |
Missing | 54 | 3 | 6,129 | 2 |
Smoking habits | ||||
Smoker | 909 | 54 | 69,571 | 23 |
Smoking occasionally | 16 | 1 | 5,178 | 2 |
Previous smoker | 213 | 13 | 70,789 | 23 |
Nonsmoker | 392 | 23 | 125,295 | 42 |
Missing | 151 | 9 | 30,124 | 10 |
Body mass index (kg/m2) | ||||
>0–<20 | 37 | 2 | 9,065 | 3 |
20–<25 | 270 | 16 | 73,199 | 24 |
25–<30 | 442 | 26 | 98,330 | 33 |
30–<50 | 808 | 48 | 106,619 | 35 |
50–100 | 40 | 3 | 1,949 | 1 |
Other (≤0 and >100) | 0 | — | 4 | <1 |
Not relevant | 23 | 1 | 3,633 | 1 |
Missing | 61 | 4 | 8,158 | 3 |
Percentage of relevant diabetes performance measures received | ||||
0–<20% | 184 | 13 | 26,503 | 10 |
20–<40% | 28 | 2 | 2,859 | 1 |
40–<60% | 88 | 6 | 13,251 | 5 |
60–<80% | 198 | 13 | 34,055 | 12 |
80%–100% | 956 | 66 | 197,412 | 72 |
Diabetes and schizophrenia (N=1,681) | Diabetes only (N=300,957) | Unadjusted analysis | ||||
---|---|---|---|---|---|---|
Variable | N | % | N | % | RR | 95% CI |
High overall quality of careb | 956 | 66 | 197,412 | 72 | .91 | .88–.95 |
Individual measure | ||||||
Glycemic monitoring | 1,227 | 96 | 241,955 | 97 | .98 | .96–1.00 |
Antidiabetic medication | 321 | 98 | 48,533 | 98 | 1.00 | .99–1.02 |
Blood pressure monitoring | 1,178 | 93 | 234,424 | 95 | .98 | .96–.99 |
Antihypertensive medication | 86 | 66 | 28,228 | 80 | .83 | .70–.97 |
Cholesterol monitoring | 1,108 | 94 | 221,457 | 95 | .99 | .97–1.01 |
Lipid-lowering medication | 38 | 70 | 7,161 | 64 | 1.09 | .89–1.35 |
Screening for albuminuria | 1,108 | 88 | 221,920 | 91 | .96 | .93–.99 |
ACE/ATII inhibitors medicationc | 27 | 59 | 7,656 | 82 | .72 | .55–.93 |
Eye examination Id | 1,075 | 86 | 214,593 | 88 | .97 | .94–.99 |
Eye examination IIe | 1,155 | 92 | 226,515 | 93 | .99 | .96–1.01 |
Feet examination | 1,097 | 87 | 220,702 | 91 | .96 | .93–.99 |
Discussion
Strengths and Limitations
Comparison With Previous Studies
Conclusions
Supplementary Material
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