Achieving diabetes treatment targets in people with registered mental illness is similar or improved compared with those without: Analyses of linked observational datasets

• Published in: Diabetic medicine Vol. 39; no. 6; pp. e14835 - n/a
• Main Authors: Nieuwenhuijse, Emma A., Struijs, Jeroen N., Sutch, Stephen P., Numans, Mattijs. E., Vos, Rimke C.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2022; John Wiley and Sons Inc
• Subjects: Blood pressure; Body mass index; Cholesterol; Diabetes; Diabetes mellitus (non-insulin dependent); diabetes mellitus, type 2; electronic health record data; Expenditures; Health care; healthcare expenditures; Low density lipoprotein; Mental disorders; Morbidity; observational data; Primary care; Research: Epidemiology; social determinants of health; treatment targets; treatment targets; social determinants of health; electronic health record data; diabetes mellitus, type 2; healthcare expenditures; observational data; mental disorders
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.14835

Aims To determine the association between registered mental illness and type 2 diabetes mellitus treatment targets, while taking into account the effects of health expenditure and social determinants of health. Methods This observational cross‐sectional study was based on routine primary care data, linked to socio‐economic and medical claims data. The main outcomes, analysed by multivariate logistic regression, were achieving primary care guideline treatment targets for HbA1c, systolic blood pressure (SBP) and LDL‐cholesterol in 2017. We examined the association with diagnosed mental illness registered by the general practitioner (GP) or treated via specialist’ mental healthcare between 2016 and 2018, adjusting for, medication use, body mass index, co‐morbidity, smoking, and additionally examining effect‐modification of healthcare expenditures, migration status, income and demographics. Results Overall (N = 2862), 64.0% of participants achieved their treatment targets for HbA1c, 65.1% for SBP and 53.0% for LDL‐cholesterol. Adjusted for migrant background, income and care expenditures, individuals <65 years of age with mental illness achieved their HbA1c treatment target more often than those without (OR (95% CI)): treatment by GP: 1.46 (1.01, 2.11), specialist care: 1.61 (1.11, 2.34), as did men with mental illness for SBP: GP OR 1.61 (1.09, 2.40), specialist care OR 1.59 (1.09, 2.45). LDL‐cholesterol target was not associated with mental illness. A migrant background or low income lowered the likelihood of reaching HbA1c targets. Conclusions People with registered mental illness appear comparable or better able to achieve diabetes treatment targets than those without. Achieving HbA1c targets is influenced by social disadvantage.