TY - JOUR T1 - The impact of severe mental illness on healthcare use and health outcomes for people with type 2 diabetes JF - British Journal of General Practice JO - Br J Gen Pract DO - 10.3399/BJGP.2020.0884 SP - BJGP.2020.0884 AU - Lu Han AU - Tim Doran AU - Richard Ian Gregory Holt AU - Catherine Hewitt AU - Rowena Jacobs AU - Stephanie Louise Prady AU - Sarah Louise Alderson AU - David Shiers AU - Han-I Wang AU - Sue Bellass AU - Simon Gilbody AU - Charlotte Emma Wray Kitchen AU - Jennie Lister AU - Johanna Taylor AU - Najma Siddiqi Y1 - 2021/02/09 UR - http://bjgp.org/content/early/2021/02/10/BJGP.2020.0884.abstract N2 - Background: People with severe mental illnesses (SMI) have reduced life expectancy compared with the general population. Diabetes is a major contributor to this disparity with higher prevalence and poorer outcomes in people with SMI. Aim: To determine the impact of SMI on healthcare processes and outcomes for diabetes. Design and setting: Retrospective observational matched nested case-control study using patient records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. Methods: We compared a range of healthcare processes (primary care consultations, physical health checks, metabolic measurements) and outcomes (prevalence and hospitalisation for cardiovascular disease (CVD), and mortality risk) for 2,192 people with SMI and type 2 diabetes (cases) with 7,773 people with diabetes alone (controls). Socio-demographics, comorbidity and medication prescription were covariates in regression models. Results: SMI was associated with increased risk of all-cause mortality (Hazard Ratio [HR]: 1.92; 95% CI: 1.60 to 2.30) and CVD-specific mortality (HR: 2.24; 1.55 to 3.25); higher physician consultation rates (Incidence Rate Ratio [IRR]: 1.15; 1.11 to 1.19); more frequent checks of blood pressure (IRR: 1.02; 1.00 to 1.05) and cholesterol (IRR: 1.04; 1.02 to 1.06); lower prevalence of angina (Odds Ratio [OR]: 0.67; 0.45 to 1.00); higher emergency admissions for angina (IRR: 1.53; 1.07 to 2.20) and lower elective admissions for ischaemic heart disease (IRR: 0.68; 0.51 to 0.92). Conclusion: Monitoring of metabolic measurements was comparable for people with diabetes with and without SMI. Increased mortality rates observed in SMI may be attributable to under-diagnosis of CVD and delays in treatment. ER -