Cardiovascular risk management among individuals with type 2 diabetes and severe mental illness: a cohort study

on behalf of the Scottish Diabetes Research Network Epidemiology Group, Jonne G ter Braake, Kelly Fleetwood, Rimke C Vos, Luke Blackbourn, Stuart McGurnaghan, Sarah H Wild, Caroline A Jackson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Aims/hypothesis: To compare cardiovascular risk management among people with type 2 diabetes, by severe mental illness (SMI) status.
Methods: We used linked electronic data to create a retrospective cohort study of adults diagnosed with type 2 diabetes in Scotland between 2004-2020, ascertaining history of SMI from hospital admission records. We compared total cholesterol, systolic blood pressure and HbA1c target level achievement one year post- diabetes diagnosis, and receipt of a statin prescription at diagnosis and one year thereafter, by SMI status using logistic regression, adjusting for sociodemographic factors and clinical history.
Results: We included 291,644 individuals with type 2 diabetes, of whom 1.0% had schizophrenia, 0.5% bipolar disorder, and 3.3% major depression. People with SMI were less likely to achieve cholesterol targets, although this did not reach statistical significance for all disorders. People with SMI were however more likely to achieve systolic blood pressure targets compared to those without SMI, with effect estimates largest for schizophrenia (males: adjusted OR 1.72, 95% CI 1.49-1.98; females: OR 1.64, 95% CI 1.38-1.96). HbA1c target achievement differed by SMI disorder and sex. Among people without previous CVD, statin prescribing was similar or better in those with versus without SMI at diabetes diagnosis and one year later. In people with prior CVD, SMI was associated with lower odds of statin prescribing at diabetes diagnosis (schizophrenia: OR 0.54, 95% CI 0.43-0.68, bipolar disorder: OR 0.75, 95% CI 0.56-1.01, major depression: OR 0.92, 95% CI 0.83-1.01), with this difference generally persisting one year later.
Conclusion/interpretation: We found SMI disparities in cholesterol target achievement and statin prescribing. This reinforces the importance of clinical review of statin prescribing for secondary prevention of CVD, particularly among people with SMI.
Original languageEnglish
JournalDiabetologia
Early online date26 Feb 2024
DOIs
Publication statusE-pub ahead of print - 26 Feb 2024

Keywords / Materials (for Non-textual outputs)

  • bipolar disorder
  • cardiovascular risk
  • cohort study
  • depression
  • diabetes management
  • mental disorders
  • schizophrenia
  • health disparities
  • clinical care

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