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. 2023 Jun 13;18(6):e0287017.
doi: 10.1371/journal.pone.0287017. eCollection 2023.

Diabetes treatment for persons with severe mental illness: A registry-based cohort study to explore medication treatment differences for persons with type 2 diabetes with and without severe mental illness

Catrine Bakkedal  1 , Frederik Persson  2 , Margit Kriegbaum  1 , John Sahl Andersen  1 , Mia Klinten Grant  1 , Grimur Høgnason Mohr  3 , Bent Struer Lind  4 , Christen Lykkegaard Andersen  1   5 , Mikkel Bring Christensen  6   7   8 , Volkert Siersma  1 , Maarten Pieter Rozing  1   9
Affiliations

Diabetes treatment for persons with severe mental illness: A registry-based cohort study to explore medication treatment differences for persons with type 2 diabetes with and without severe mental illness

Catrine Bakkedal et al. PLoS One. .

Abstract

It has been argued that persons with severe mental illness (SMI) receive poorer treatment for somatic comorbidities. This study assesses the treatment rates of glucose-lowering and cardiovascular medications among persons with incident type 2 diabetes (T2D) and SMI compared to persons with T2D without SMI. We identified persons ≥30 years old with incident diabetes (HbA1c ≥ 48 mmol/mol and/or glucose ≥ 11.0 mmol/L) from 2001 through 2015 in the Copenhagen Primary Care Laboratory (CopLab) Database. The SMI group included persons with psychotic, affective, or personality disorders within five years preceding the T2D diagnosis. Using a Poisson regression model, we calculated the adjusted rate ratios (aRR) for the redemption of various glucose-lowering and cardiovascular medications up to ten years after T2D diagnosis. We identified 1,316 persons with T2D and SMI and 41,538 persons with T2D but no SMI. Despite similar glycemic control at diagnosis, persons with SMI redeemed a glucose-lowering medication more often than persons without SMI in the period 0.5-2 years after the T2D diagnosis; for example, the aRR was 1.05 (95% CI 1.00-1.11) in the period 1.5-2 years after the T2D diagnosis. This difference was mainly driven by metformin. In contrast, persons with SMI were less often treated with cardiovascular medications during the first 3 years after T2D diagnosis, e.g., in the period 1.5-2 years after T2D diagnosis, the aRR was 0.96 (95% CI 0.92-0.99). For people with SMI in addition to T2D, metformin is more likely to be used in the initial years after T2D diagnosis, while our results suggest potential room for improvement regarding the use of cardiovascular medications.

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Conflict of interest statement

‘I have read the journal’s policy and the authors of this manuscript have the following competing interests: CB has been employed as part of her specialization in Clinical Pharmacology in Novo Nordisk in a 1-year position that ended in 2018. FP has served as a consultant, on advisory boards or as educator for AstraZeneca, Novo Nordisk, Boehringer Ingelheim, Sanofi, Mundipharma, MSD, Novartis, Amgen and has received research grants to institution from Novo Nordisk, Boehringer Ingelheim, Amgen and AstraZeneca. This does not alter our adherence to PLOS ONE policies on sharing data and materials”.

Figures

Fig 1
Fig 1. Flowchart of the study population.
HbA1c = glycated haemoglobin, ATC = anatomical therapeutic classification, SMI = severe mental illness.
Fig 2
Fig 2. Redemption rates of glucose-lowering medications for persons with T2D and SMI versus those without SMI.
Data are presented as rate ratios (RR) adjusted for sex, age (quadratic), glycaemic control at index, comorbidities preceding the index, calendar year and level of education. Each bar represents the estimate and 95% confidence interval for each period á six months. DPP4-inhibitors = dipeptidyl peptidase 4 inhibitors, GLP1-RAs = glucagon-like peptide 1 rector agonists, SGLT2-inhibitors = sodium = glucose cotransporter 2 inhibitors.
Fig 3
Fig 3. Redemption rates of cardiovascular medications for persons with T2D and SMI versus those without SMI.
Data are presented as rate ratios (RR) adjusted for sex, age (quadratic), glycaemic control at index, comorbidities preceding the index, calendar year and level of education. Each bar represents the estimate and 95% confidence interval for each period a six months.
See this image and copyright information in PMC

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