People with severe mental illness, particularly racial minorities, face a much greater risk of having prediabetes or Type 2 diabetes, according to a new study at the University of California, San Francisco (UCSF). The researchers suggest that all patients with severe mental illness be screened for diabetes.
The findings, published in the journal Diabetes Care, show that among more than 15,000 patients with severe mental illness, 28.1 percent had Type 2 diabetes compared with 12.2 percent in the general population.
Racial minorities face an even greater risk. For those with severe mental illness, the incidence of Type 2 diabetes is 36.9 percent for Hispanics, 36.3 percent for African Americans and 30.7 percent for Asians — compared with 25.1 percent for whites.
“The results of the study indicate that we should be screening all patients with severe mental illness for diabetes,” said first author Christina Mangurian, M.D., M.A.S., who is Vice Chair for Diversity and Health Equity in the UCSF Department of Psychiatry and a member of the UCSF Weill Institute for Neurosciences.
“I view this as an opportunity to change how doctors think about health screening and to help prevent diabetes. By diagnosing prediabetes early, we can help patients make lifestyle modifications or start medicine so that they don’t develop diabetes.”
The study follows previous research linking severe mental illness to low rates of testing for diabetes and HIV, and among women, low rates of screening for cervical cancer.
“Antipsychotic medications prescribed for conditions like schizophrenia and bipolar disorder may cause weight gain and impact cholesterol levels and insulin resistance,” said Mangurian.
“Additionally, people with severe mental illness have more tenuous life circumstances, including food insecurity, low income and unstable housing situations, which all increase their risk of diabetes. Stressors such as structural racism compound these problems in minorities.”
Prediabetes was also found to be high among patients with severe mental illness. Nearly half of subjects with severe mental illness had prediabetes, versus an estimated one-third of the general population. The condition was more common among minorities and often developed in people as young as 20 years old.
The study, which used a mental health database collected by Kaiser Permanente Northern California, involved patients who were also in the Kaiser Permanente diabetes registry and assessed the prevalence of prediabetes by analyzing patients’ hemoglobin A1C and fasting glucose levels.
“We were able to leverage Kaiser Permanente’s extensive electronic health record data to improve our understanding of the burden of diabetes and prediabetes in people with severe mental illness and develop insights on how to address racial/ethnic and age disparities in this high-risk population,” said senior author Julie Schmittdiel, Ph.D., research scientist at the Kaiser Permanente Northern California Division of Research.