Disparities in Diabetes Care: Impact of Mental Illness
Abstract
BACKGROUND: Emerging evidence indicates that patients with mental health conditions (MHCs) may receive less intensive medical care. Diabetes serves as a useful condition in which to test for MHC-related disparities in care. We examined whether quality measures for diabetes care are worse for patients with or without MHCs. METHODS: This national, cross-sectional study included 313 586 noninstitutionalized Veterans Health Administration patients with diabetes (identified from diagnostic codes and prescriptions) whose Veterans Health Administration facility transmitted laboratory data to a central database; 76 799 (25%) had MHCs (based on diagnostic codes for depressed mood, anxiety, psychosis, manic symptoms, substance use disorders, personality disorders, and other categories). National data from Veterans Health Administration records, Medicare claims, and a national survey were linked to characterize 1999 diabetes care. RESULTS: Failure to meet diabetes performance measures was more common in patients with MHCs: unadjusted odds ratio (95% confidence interval) was 1.24 (1.22-1.27) for no hemoglobin A(1c) testing, 1.25 (1.23-1.28) for no low-density lipoprotein cholesterol testing, 1.05 (1.03-1.07) for no eye examination, 1.32 (1.30-1.35) for poor glycemic control, and 1.17 (1.15-1.20) for poor lipemic control. Disparities persisted after case mix adjustment and were more pronounced with specific MHCs (psychotic, manic, substance use, and personality disorders). The percentage not meeting diabetes care standards increased with increasing number of MHCs. CONCLUSION: Patients with mental illness merit special attention in national diabetes quality improvement efforts.
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Underdiagnosis of somatic disorders in schizophrenic patients has been described in many studies.
“Underdiagnosis of somatic disorders in schizophrenic patients has been described in many other studies (Frayne et al. 2005, Laursen et al. 2009, Osborn et al. 2008).”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Frayne et al. 2005
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- Authors
- Frayne, S. M., Halanych, J. H., Miller, D. R., Wang, F., Lin, H., Pogach, L., Sharkansky, E. J., Keane, T. M., Skinner, K. M., Rosen, C. S., & Berlowitz, D. R.
- Affiliations
- Edith Nourse Rogers Memorial Veterans Hospital (US)
- ORCID
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2005-12-12
- Volume
- 165
- Issue
- 22
- Pages
- 2631
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2127424395
- Cited by
- 336
- References
- 5
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 8 · 2021: 8 · 2020: 14 · 2019: 12 · 2018: 9 · 2017: 43 · 2016: 7 · 2015: 21 · 2014: 23 · 2013: 21 · 2012: 25
- FWCI
- 10.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- diabetes management, mental illness, health care disparities, veterans, quality of care, glycemic control, hemoglobin A1c testing, LDL cholesterol testing, eye examination, substance use disorders, psychosis, manic disorder, personality disorders, depression, anxiety, risk adjustment
- MeSH terms
- Age Factors, Aged, Mental Disorders, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Sex Factors, United States, Veterans, Cohort Studies, Health Care Surveys, Quality Indicators, Health Care, Databases as Topic, Racial Groups, Diabetes Complications
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