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In a new California study, fewer than one-third of mental health patients were screened for type 2 diabetes, despite an elevated risk for the disorder, the researchers reported in the Nov. 9 online edition of the journal JAMA Internal Medicine.
Treatment with antipsychotic drugs contributes to this risk, the researchers explained. This class of drugs includes clozapine (Clozaril), olanzapine (Zyprexa) and risperidone (Risperdal), among others. Anyone taking them should undergo diabetes screening every year, the American Diabetes Association says.
"To improve care for persons with serious mental illness, it will be necessary to break down the silos that separate the mental health and physical health care systems," journal deputy editor Dr. Mitchell Katz wrote in a related editor's note. Katz is director of the Los Angeles County Department of Health Services.
Researchers looked at diabetes screening at different points between 2009 and 2011 among nearly 51,000 people in the California public mental health care system. All had severe mental illness, such as schizophrenia or bipolar disorder, and were taking antipsychotic medicines.
The study found that about 30 percent of the patients received diabetes-specific screening; about 39 percent received nonspecific diabetes screening; and 31 percent received no screening.
The strongest factor associated with diabetes-specific screening was having at least one outpatient visit to a primary care provider during the study period.
The findings support "efforts to integrate behavioral health and primary care," Dr. Christina Mangurian, of the University of California, San Francisco, and colleagues wrote in the report.
"Growing evidence supports the value of screening for diabetes mellitus in higher-risk populations, such as those receiving treatment with antipsychotic medications, including first-generation and second-generation agents that commonly result in co-occurring obesity. Future studies should explore barriers to screening in this vulnerable population," the researchers concluded.
-- Robert Preidt
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