medwireNews: People with type 2 diabetes who have mental health conditions are just as likely as those who do not to achieve their blood glucose targets, report researchers.
For some subgroups, in fact, having a mental health diagnosis was associated with an increased likelihood of achieving targets – for systolic blood pressure (SBP) as well as glycated hemoglobin (HbA1c).
Emma Nieuwenhuijse (Leiden University Medical Centre, the Netherlands) and co-researchers used routine primary care records to obtain data on 2862 people, aged an average of 61.8 years, who had received a type 2 diabetes diagnosis at least 1 year previously. Twenty-three percent of these people also had a mental illness diagnosis, with about half requiring specialist mental healthcare.
The overall study cohort was “a multi-ethnic socio-economically diverse urbanised population,” notes the team, with approximately half of the participants having a migrant background.
Overall, 64% of the cohort had HbA1c that was at or below target, as did 65% of those receiving treatment for mental illness in primary care and 60% of those receiving specialist care.
Mental illness itself was not significantly associated with attainment of HbA1c target, or of SBP or cholesterol targets. However, among people younger than 65 years having a mental health diagnosis was associated with a significantly increased likelihood of achieving HbA1c targets, at a 1.46-fold and 1.61-fold increase for those receiving primary and specialist mental healthcare, respectively.
Additionally, men with a mental health diagnosis were more likely than those without to achieve SBP targets.
Other factors affecting the likelihood of achieving HbA1c targets were being 65 years or older with a high income, which increased the likelihood, and being of a migrant background, which reduced it.
Being in receipt of glucose-lowering or antihypertensive medications was perversely associated with a reduced likelihood of achieving HbA1c and SBP targets, respectively, but the researchers believe this “may be explained by a tendency amongst doctors to prescribe medication in response to a failure to reach targets.”
Finally, Nieuwenhuijse and team found that people whose mental illness had lasted for more than a year were significantly more likely to reach their HbA1c and SBP targets than those with a shorter duration of illness, “suggesting that disruption due to mental illness can only be improved by recognition and treatment of problems.”
The team concludes in Diabetic Medicine: “Diabetes monitoring and recognition of mental illness appear to represent the ‘protective key’ in the association of mental illness with achieving treatment targets.
“All diabetes monitoring visits should therefore address psychological disturbance, and attendance should be encouraged.”
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Diabet Med 2022; doi:10.1111/dme.14835