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Research Letter |

Diabetes Screening Among Underserved Adults With Severe Mental Illness Who Take Antipsychotic Medications

Christina Mangurian, MD1,2; John W. Newcomer, MD3; Eric Vittinghoff, PhD4; Jennifer M. Creasman, MSPH5; Penelope Knapp, MD6; Elena Fuentes-Afflick, MD, MPH4,7; Dean Schillinger, MD2,8
[+] Author Affiliations
1Department of Psychiatry, University of California, San Francisco
2Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco
3Department of Integrated Medical Science, The Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton
4Department of Epidemiology and Biostatistics, University of California, San Francisco
5Department of Obstetrics and Gynecology, University of California, San Francisco
6Department of Psychiatry and Behavioral Sciences, University of California, Davis
7Department of Pediatrics, University of California, San Francisco
8Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2015;175(12):1977-1979. doi:10.1001/jamainternmed.2015.6098.
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This retrospective cohort study analyzes diabetes screening prevalence and predictors of screening among adults in the California public mental health care system with severe mental illness taking antipsychotic medications.

Adults in the United States with severe mental illness (SMI), such as schizophrenia and bipolar disorder (totaling approximately 7 million), are estimated to die, on average, 25 years earlier than the general population, largely of premature cardiovascular disease.1 The Institute of Medicine2 has called for improvements in health care for this population. Severe mental illness is associated with elevated risk for type 2 diabetes mellitus.3 Treatment with antipsychotic medications contributes to risk, with most evidence focused on second-generation antipsychotic medications, but similar increases in risk are reported with older and newer medications.4 The American Diabetes Association5 recommends annual diabetes screening for patients treated with antipsychotic medications, and public health administrators have targeted this population for improved health screening.6 To our knowledge, no studies have examined screening rates in this highest-risk population of adults with SMI because of limitations in public health medical records. We examined diabetes screening among publicly insured adults with SMI taking antipsychotic medications using matched administrative data for physical and mental health care services in a large health care system. We measured diabetes screening prevalence among patients with SMI treated with antipsychotic medications and assessed characteristics predictive of screening.

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