Mental illness and intensification of diabetes medications: an observational cohort study

BMC Health Services Research

Rudolf Moos³  Tina T Lee³  Kaajal J Laungani²  Leonard M Pogach¹  Donald R Miller⁴  Dan R Berlowitz⁴  Mary K Goldstein⁶  Eric Berg²  Tyson H Holmes³  Susan M Frayne⁵ 

[1] Rutgers University-New Jersey Medical School, Newark, NJ, USA;Department of Veterans Affairs HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA;Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA;Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA;Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA;Department of Veterans Affairs Geriatrics Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA

关键词: Health services research;    Veterans;    Hypoglycemic agents/therapeutic use;    Health care delivery;    Diabetes mellitus/therapy;    Psychiatric diagnosis;   

Others  :  1125867
DOI  :  10.1186/1472-6963-14-458

 received in 2014-02-26, accepted in 2014-09-08,  发布年份 2014

【 摘 要 】

Background

Mental health condition (MHC) comorbidity is associated with lower intensity care in multiple clinical scenarios. However, little is known about the effect of MHC upon clinicians’ decisions about intensifying antiglycemic medications in diabetic patients with poor glycemic control. We examined whether delay in intensification of antiglycemic medications in response to an elevated Hemoglobin A1c (HbA1c) value is longer for patients with MHC than for those without MHC, and whether any such effect varies by specific MHC type.

Methods

In this observational study of diabetic Veterans Health Administration (VA) patients on oral antiglycemics with poor glycemic control (HbA1c ≥8) (N =52,526) identified from national VA databases, we applied Cox regression analysis to examine time to intensification of antiglycemics after an elevated HbA1c value in 2003–2004, by MHC status.

Results

Those with MHC were no less likely to receive intensification: adjusted Hazard Ratio [95% CI] 0.99 [0.96-1.03], 1.13 [1.04-1.23], and 1.12 [1.07-1.18] at 0–14, 15–30 and 31–180 days, respectively. However, patients with substance use disorders were less likely than those without substance use disorders to receive intensification in the first two weeks following a high HbA1c, adjusted Hazard Ratio 0.89 [0.81-0.97], controlling for sex, age, medical comorbidity, other specific MHCs, and index HbA1c value.

Conclusions

For most MHCs, diabetic patients with MHC in the VA health care system do not appear to receive less aggressive antiglycemic management. However, the subgroup with substance use disorders does appear to have excess likelihood of non-intensification; interventions targeting this high risk subgroup merit attention.

【 授权许可】

   
2014 Frayne et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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