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Abstract
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.
- schizophrenia
- diabetes mellitus
- type 2
- epidemiology
- glycated hemoglobin A
Data availability statement
Data may be obtained from a third party and are not publicly available. Data for this study are deidentified participant data. Data are not publicly available. Inquiries for data use should be directed to the authors and may be available subject to appropriate approvals.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Data for this study are deidentified participant data. Data are not publicly available. Inquiries for data use should be directed to the authors and may be available subject to appropriate approvals.
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Footnotes
Contributors JD-M conceived of the study and led all analyses. All authors were involved in the study design. RM was responsible for data acquisition. All authors contributed to the interpretation of the data and drafting of the work as well as revising it critically for important intellectual content. All authors have approved the final version of the manuscript to be published and agree to be accountable for all aspects of the work. JD-M is the guarantor for all analyses.
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).
Disclaimer The views expressed are those of the author(s) and not necessarily those of the ESRC, NIHR, the Department of Health and Social Care, or King’s College London.
Competing interests FG has received support or honoraria from Lundbeck, Otsuka, and Sunovion, and has a family member with previous professional links to Lilly and GSK. RS has received research support in the last 3 years from Janssen, GSK, and Takeda. RM has received consulting fees from AMGEN.
Provenance and peer review Not commissioned; externally peer reviewed.
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