QUALITY OF DIABETES CARE AMONG PERSONS WITH TYPE 2 DIABETES WITH AND WITHOUT SEVERE MENTAL ILLNESS

Methods: We constructed a prospective cohort study based on national Danish healthcare registers and identified all persons with T2D as of 01.01.2015 with and without SMI defined as diagnosis of schizophrenia, bipolar disorder or depressive disorder. Quality of diabetes care indicators were measured as one assessment of each of the following; HbA1c, LDL-cholesterol, urinary albumin-creatinine ratio (UACR), foot examination, and eye screening between 01.01.2015 and 31.12.2019. Difference in quality of diabetes care between persons with and without SMI was measured for each indicator as the odds ratio of at least one measurement during follow-up using logistic regression models. Model 1 was adjusted for age, sex and diabetes duration and model 2 additionally for education and immigration status.
Results: We included 173,742 persons with T2D of which 11,794 have had a hospital contact with SMI (4,457 schizophrenia, 1,530 bipolar disorder and 8,373 had depression). Mean age at start of follow-up was 60 and 65 years in persons with and without SMI, respectively. Odds Ratio (OR) for having at least one assessment during the follow-up period in persons with SMI compared to persons without are presented in Table 1. Persons with any SMI were more likely to have an assessment of HbA1c (OR=1.22; 95% CI 1.06 – 1.40) or LDL-cholesterol (OR=1.24; 95%CI 1.10 – 1.39), but less likely to have an assessment of UACR (OR=0.70; 95%CI 0.66 – 0.74) or eye screening (OR=0.66; 95% CI 0.63 – 0.69). There was no difference in the odds for foot examination. Findings were similar for each type of SMI.
Conclusion: Quality of diabetes care differs in persons with T2D with and without co-existing SMI. Persons with T2D and co-existing SMI are more likely to have an assessment of HbA1c and LDL-cholesterol but less likely to have an assessment of UACR or eye screening compared to persons with T2D only.