Mentally ill risk getting poor diabetes care

Diabetics with mental health conditions are less likely to receive optimum diabetes care, according to the results of a large study published in the Archives of Internal Medicine.

Diabetes is one of several medical conditions that patients with mental illness may also have, and up to 30 percent of the US population is thought to have some type of mental illness.

"From a public health perspective, the aggregate effect of mental health conditions on medical care could prove to be quite substantial," Dr. Susan M. Frayne of the Veterans Administration Health Services Research and Development Centers of Excellence in Bedford, Massachusetts, told Reuters Health.

The investigation was not designed to determine why such disparities in care might occur, she added. "The differences that we did see could be related to patient factors such as difficulty adhering to medication, or provider factors such as the nature of the interaction between providers and patients, or health care system factors such as difficulty with integration of mental and medical health services," Frayne said.

Frayne and her colleagues looked at data for 313,586 VA patients with diabetes, 25 percent of whom had some type of mental health condition.

Patients with a mental health condition were 24 percent more likely not to have had hemoglobin A1c testing, 24 percent more likely not to have had their low-density cholesterol tested, and 5 percent more likely not to have had an eye exam, the researchers found. Those with mental health conditions were also 32 percent more likely to have poor control over blood sugar levels.

The effect was more pronounced for psychosis, mania, substance use and personality disorders than for anxiety and depression, the researchers found. And the more mental health conditions a person had, the less likely he was to be receiving optimum care.

For example, 24 percent of patients with no mental health conditions had poor blood sugar control, compared with 28 percent of patients with one condition, 31 percent of those with three conditions, and 41 percent for patients with six diagnosed mental health conditions.

"Patients with mental illness merit special attention in national diabetes quality improvement efforts," the researchers conclude.

More research is needed to investigate why such disparities occur, so that they can be remedied, Frayne added.

SOURCE: Archives of Internal Medicine, December 2005.