Patients on Antipsychotics Rarely Screened for Diabetes

the Psychiatry Advisor take:

Those with severe mental illness are rarely tested for diabetes despite their high risk for developing it, according to research published in the JAMA Internal Medicine.

The American Diabetes Association and American Psychiatric Association both recommend testing patients on antipsychotic medications for diabetes once a year, but upon examining a cohort of 50,915 adults with severe mental illness who are on Medicaid, more than 70% did not receive a diabetes-specific test. However, those who also had at least one primary care visit were more than twice as likely to be screened.

These findings point to a need for greater mental and physical health care integration. "Our healthcare system is fragmented for people with mental illness. For example, the mental health electronic medical record is totally separate from their primary care electronic record, truly limiting the quality of care this vulnerable population can receive," said Christina Mangurian, MD, MAS, associate professor of clinical psychiatry at the University of California, San Francisco School of Medicine.

Those with severe mental illness are two to three times more likely to have type 2 diabetes than the general population. Many factors contribute to this including smoking, sedentary lifestyle, and food insecurity due to poverty, and antipsychotic medications, which disrupt metabolic function and can cause patients to rapidly gain weight, increase the chances even more.

If the health care system was better integrated, mental and physical health records could each be accessible to the other, allowing clinicians to easily see which patients are at a higher risk for certain condition, the researchers argue. This is especially important for young adults, who are at the age most at risk for developing psychotic illnesses.

Patients on Antipsychotics Rarely Screened for Diabetes
70% of severely mentally ill patients on Medicaid were not tested for diabetes, despite having a two to three times greater risk.

Although adults with serious psychiatric disorders are at high risk for diabetes, a large study led by UC San Francisco reveals that low-income patients on Medicaid are rarely screened for it. The findings support growing efforts to integrate mental health services and primary care to improve diagnosis and treatment of medical issues associated with mental illness, the researchers said.

Individuals with severe mental illness (SMI) are two to three times more likely to have type 2 diabetes than the general population. Many factors contribute to the increased risk, and treatment with antipsychotic medication raises the risk even further. The American Diabetes Association and American Psychiatric Association both recommend that providers do annual diabetes screening for any patients taking antipsychotic medications, but until now it has been unclear how often screenings actually occur.

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