TY - JOUR
T1 - Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses
T2 - Cohort study from the UK over 10 years
AU - Das-Munshi, Jayati
AU - Schofield, Peter
AU - Ashworth, Mark
AU - Gaughran, Fiona
AU - Hull, Sally
AU - Ismail, Khalida
AU - Robson, John
AU - Stewart, Robert
AU - Mathur, Rohini
N1 - Funding Information:
Funding JD-M is part-supported by the ESRC Centre for Society and Mental Health at King’s College London (ESRC Reference: ES/S012567/1), grants from the ESRC (ES/S002715/1), by the Health Foundation working together with the Academy of Medical Sciences, for a Clinician Scientist Fellowship, and by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the NIHR Applied Research Collaboration South London (ARC South London) at King’s College Hospital NHS Foundation Trust. FG is in part supported by the NIHR's Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, the Maudsley Charity and the NIHR Applied Research Collaboration South London (ARC South London) at King’s College Hospital NHS Foundation Trust. RS is part-funded by the NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King’s College London; a Medical Research Council (MRC) Mental Health Data Pathfinder Award to King’s College London; an NIHR Senior Investigator Award; and the NIHR Applied Research Collaboration South London (ARC South London) at King’s College Hospital NHS Foundation Trust. PS is part funded by an MRC research grant (MRC Reference MR/ S025510/1). KI is funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. RM is funded by a Sir Henry Wellcome Postdoctoral Fellowship (201375/Z/16/Z).
Publisher Copyright:
© Authors 2021
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/9/8
Y1 - 2021/9/8
N2 - Introduction Using data from a a primary care pay-for-performance scheme targeting quality indicators, the objective of this study was to assess if people living with type 2 diabetes mellitus (T2DM) and severe mental illnesses (SMI) experienced poorer glycemic management compared with people living with T2DM alone, and if observed differences varied by race/ethnicity, deprivation, gender, or exclusion from the scheme. Research design and methods Primary care data from a cohort of 56 770 people with T2DM, including 2272 people with T2DM and SMI, from London (UK), diagnosed between January 17, 2008 and January 16, 2018, were used. Adjusted mean glycated hemoglobin (HbA1c) and HbA1c differences were assessed using multilevel regression models. Results Compared with people with T2DM only, people with T2DM/SMI were more likely to be of an ethnic minority background, excluded from the pay-for-performance scheme and residing in more deprived areas. Across the sample, mean HbA1c was lower in those with T2DM and SMI (mean HbA1c: 58 mmol/mol; 95% CI 57 to 59), compared with people with T2DM only (mean HbA1c: 59 mmol/mol; 95% CI 59 to 60). However, HbA1c levels were greater in Bangladeshi, Indian, Pakistani, and Chinese people compared with the White British reference in the T2DM/SMI group. People with T2DM/SMI who had been excluded from the pay-for-performance scheme, had HbA1c levels which were +7 mmol/mol (95% CI 2 to 11) greater than those with T2DM/SMI not excluded. Irrespective of SMI status, increasing deprivation and male gender were associated with increased HbA1c levels. Conclusions Despite a pay-for-performance scheme to improve quality standards, inequalities in glycemic management in people with T2DM and SMI persist in those excluded from the scheme and by gender, ethnicity, and area-level deprivation.
AB - Introduction Using data from a a primary care pay-for-performance scheme targeting quality indicators, the objective of this study was to assess if people living with type 2 diabetes mellitus (T2DM) and severe mental illnesses (SMI) experienced poorer glycemic management compared with people living with T2DM alone, and if observed differences varied by race/ethnicity, deprivation, gender, or exclusion from the scheme. Research design and methods Primary care data from a cohort of 56 770 people with T2DM, including 2272 people with T2DM and SMI, from London (UK), diagnosed between January 17, 2008 and January 16, 2018, were used. Adjusted mean glycated hemoglobin (HbA1c) and HbA1c differences were assessed using multilevel regression models. Results Compared with people with T2DM only, people with T2DM/SMI were more likely to be of an ethnic minority background, excluded from the pay-for-performance scheme and residing in more deprived areas. Across the sample, mean HbA1c was lower in those with T2DM and SMI (mean HbA1c: 58 mmol/mol; 95% CI 57 to 59), compared with people with T2DM only (mean HbA1c: 59 mmol/mol; 95% CI 59 to 60). However, HbA1c levels were greater in Bangladeshi, Indian, Pakistani, and Chinese people compared with the White British reference in the T2DM/SMI group. People with T2DM/SMI who had been excluded from the pay-for-performance scheme, had HbA1c levels which were +7 mmol/mol (95% CI 2 to 11) greater than those with T2DM/SMI not excluded. Irrespective of SMI status, increasing deprivation and male gender were associated with increased HbA1c levels. Conclusions Despite a pay-for-performance scheme to improve quality standards, inequalities in glycemic management in people with T2DM and SMI persist in those excluded from the scheme and by gender, ethnicity, and area-level deprivation.
KW - diabetes mellitus
KW - epidemiology
KW - glycated hemoglobin A
KW - schizophrenia
KW - type 2
UR - http://www.scopus.com/inward/record.url?scp=85114766223&partnerID=8YFLogxK
U2 - 10.1136/bmjdrc-2021-002118
DO - 10.1136/bmjdrc-2021-002118
M3 - Article
AN - SCOPUS:85114766223
SN - 2052-4897
VL - 9
JO - BMJ Open Diabetes Research and Care
JF - BMJ Open Diabetes Research and Care
IS - 1
M1 - e002118
ER -