1
|
Kuo WY, Tsai WC, Kung PT. Participation and Outcomes among Disabled and Non-Disabled People in the Diabetes Pay-for-Performance Program. Healthcare (Basel) 2023; 11:2742. [PMID: 37893816 PMCID: PMC10606631 DOI: 10.3390/healthcare11202742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES This study's objectives were to compare the participation rates of people with and without disabilities who had type 2 diabetes in a diabetes pay-for-performance (DM P4P) program, as well as their care outcomes after participation. METHODS This was a retrospective cohort study. The data came from the disability registry file, cause of death file, and national health insurance research database of Taiwan. The subjects included patients newly diagnosed with type 2 diabetes between 2001 and 2013 who were followed up with until 2014 and categorized as disabled and non-disabled patients. The propensity score matching method was used to match the disabled with the non-disabled patients at a 1:1 ratio. Conditional logistic regression analysis was used to determine the odds ratio between the disabled and non-disabled patients who joined the P4P program. The Cox hazard model was used to compare the risk of dialysis and death between the disabled and non-disabled patients participating in the P4P program. RESULTS There were 110,645 disabled and 110,645 non-disabled individuals after matching. After controlling for confounding factors, it was found that the disabled individuals were significantly less likely (odds ratio = 0.89) to be enrolled in the P4P program than the non-disabled individuals. The risk of dialysis was 1.08 times higher for people with disabilities than those without, regardless of their participation in the P4P program. After enrollment in the P4P program, the risk of death for people with disabilities decreased from 1.32 to 1.16 times that of persons without disabilities. Among the people with disabilities, the risk of death for those enrolled in the P4P program was 0.41 times higher than that of those not enrolled. The risk of death was reduced to a greater extent for people with disabilities than for those without disabilities upon enrollment in the DM P4P program. CONCLUSION People with disabilities are less likely to be enrolled in the P4P program in Taiwan and have unequal access to care. However, the P4P program was more effective at reducing mortality among people with disabilities than among those without.
Collapse
Affiliation(s)
- Wei-Yin Kuo
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-Y.K.); (W.-C.T.)
| | - Wen-Chen Tsai
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-Y.K.); (W.-C.T.)
- Department of Medical Research, China Medical University Hospital, Taichung 404332, Taiwan
| | - Pei-Tseng Kung
- Department of Medical Research, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Healthcare Administration, Asia University, Taichung 413305, Taiwan
| |
Collapse
|
2
|
Wang Y, Zeng L, Chen L, Zhou X, Huo L, Wang T, Zhou Y, Zhang X. The prevalence and clinical characteristics of diabetes mellitus in Chinese inpatients with chronic schizophrenia: a multicenter cross-sectional study. PeerJ 2021; 9:e12553. [PMID: 34909279 PMCID: PMC8641481 DOI: 10.7717/peerj.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 11/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background Diabetes mellitus (DM) is common among patients with schizophrenia. However, information on patients comorbid DM and schizophrenia is limited in China. The present study investigated the prevalence of DM and its clinical characteristics in Chinese inpatients with chronic schizophrenia. Methods A cross-sectional study was performed in Chinese inpatients with chronic schizophrenia. Diagnosis of Diabetes was established using World Health Organization diagnostic criteria for diabetes mellitus (persistent fasting glucose levels ≥ 126 mg/dl or 2-h plasma glucose ≥ 200 mg/dL after a 75-g Oral Glucose Tolerance Test). Patients were also measured height, weight, waist circumference, hip circumference, triglyceride level, and cholesterol level. Patients’ psychiatric symptoms were measured by the Positive and Negative Syndrome Scale (PANSS). Binary logistic regression analysis was performed to examine the associated demographic and clinical variables in chronic schizophrenia. Results A total of 988 inpatients (64.6% male, average age of 47.19 ± 12.55) was recruited. The prevalence of DM in Chinese patients with chronic schizophrenia was 13.8% (95% CI [11.6–15.9]%). Logistic regression analysis showed that overweight (OR = 1.90, 95% CI [1.20–3.03], p = 0.006), obesity (OR = 1.85, 95% CI [1.07–3.21], p = 0.028), comorbid hypertension (OR = 2.14, 95% CI [1.34–3.42], p = 0.002), and course of schizophrenia (OR = 1.03, 95% CI [1.01–1.06], p = 0.040) were significantly associated with the DM risk in patients with schizophrenia. Conclusion The findings indicated that diabetes mellitus was non-negligible in patients with chronic schizophrenia. Patients with schizophrenia should be regularly monitored for DM. Overweight/obesity, long duration of schizophrenia, and comorbid hypertension possibly were risk factors for diabetes.
Collapse
Affiliation(s)
- Yanni Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou, China
| | - Lingyun Zeng
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, China
| | - Lijuan Chen
- School of Literature, Journalism & Communication, South-Central University for Nationalities, Wuhan, China
| | - Xin Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Lijuan Huo
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tingwei Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
3
|
Bergantin LB. A link among schizophrenia, diabetes, and asthma: Role of Ca2 +/cAMP signaling. Brain Circ 2020; 6:145-151. [PMID: 33210037 PMCID: PMC7646390 DOI: 10.4103/bc.bc_66_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/29/2020] [Accepted: 08/13/2020] [Indexed: 01/18/2023] Open
Abstract
Asthma has been associated with an increased risk for developing schizophrenia. In addition, schizophrenia has been associated with an increased risk for developing type 2 diabetes mellitus, resulting in an elevated cardiovascular risk and in a limited life expectancy. It is well discussed that dysregulations related to Ca2+ signaling could link these diseases, in addition to cAMP signaling pathways. Thus, revealing this interplay among schizophrenia, diabetes, and asthma may provide novel insights into the pathogenesis of these diseases. Publications involving Ca2+ and cAMP signaling pathways, schizophrenia, diabetes, and asthma (alone or combined) were collected by searching PubMed and EMBASE. Both Ca2+ and cAMP signaling pathways (Ca2+/cAMP signaling) control the release of neurotransmitters and hormones, in addition to airway smooth muscle contractility, then dysregulations of these cellular processes may be involved in these diseases. Taking into consideration, the experience of our group in this field, this narrative review debated the involvement of Ca2+/cAMP signaling in this link among schizophrenia, diabetes, and asthma, including its pharmacological implications.
Collapse
Affiliation(s)
- Leandro Bueno Bergantin
- Department of Pharmacology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
4
|
Habtewold TD, Islam MA, Liemburg EJ, Bruggeman R, Alizadeh BZ. Polygenic risk score for schizophrenia was not associated with glycemic level (HbA1c) in patients with non-affective psychosis: Genetic Risk and Outcome of Psychosis (GROUP) cohort study. J Psychosom Res 2020; 132:109968. [PMID: 32169752 DOI: 10.1016/j.jpsychores.2020.109968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Type 2 diabetes (T2D) is a common comorbidity in patients with schizophrenia (SCZ). The underlying pathophysiologic mechanisms are yet to be fully elucidated, although it can be argued that shared genes, environmental factors or their interaction effect are involved. This study investigated the association between polygenic risk score of SCZ (PRSSCZ) and glycated haemoglobin (HbA1c) while adjusting for polygenic risk score of T2D (PRST2D), and clinical and demographic covariables. METHODS Genotype, clinical and demographic data of 1129 patients with non-affective psychosis were extracted from Genetic Risk and Outcome of Psychosis (GROUP) cohort study. The glycated haemoglobin (HbA1c) was the outcome. PRS was calculated using standard methods. Univariable and multivariable linear regression analyses were applied to estimate associations. Additionally, sensitivity analysis based on multiple imputation was done. After correction for multiple testing, a two-sided p-value ≤.003 was considered to discover evidence for an association. RESULTS Of 1129 patients, 75.8% were male with median age of 29 years. The mean (standard deviation) HbA1c level was 35.1 (5.9) mmol/mol. There was no evidence for an association between high HbA1c level and increased PRSSCZ (adjusted regression coefficient (aβ) = 0.69, standard error (SE) = 0.77, p-value = .37). On the other hand, there was evidence for an association between high HbA1c level and increased PRST2D (aβ = 0.93, SE = 0.32, p-value = .004), body mass index (aβ = 0.20, SE = 0.08, p-value = .01), diastolic blood pressure (aβ = 0.08, SE = 0.04, p-value = .03), late age of first psychosis onset (aβ = 0.19, SE = 0.05, p-value = .0004) and male gender (aβ = 1.58, SE = 0.81, p-value = .05). After multiple testing correction, there was evidence for an association between high HbA1c level and late age of first psychosis onset. Evidence for interaction effect between PRSscz and antipsychotics was not observed. The multiple imputation-based sensitivity analysis provided consistent results with complete case analysis. CONCLUSIONS Glycemic dysregulation in patients with SCZ was not associated with PRSSCZ. This suggests that the mechanisms of hyperglycemia or diabetes are at least partly independent from genetic predisposition to SCZ. Our findings show that the change in HbA1c level can be caused by at least in part due to PRST2D, late age of illness onset, male gender, and increased body mass index and diastolic blood pressure.
Collapse
Affiliation(s)
- Tesfa Dejenie Habtewold
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands.
| | - Md Atiqul Islam
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; Shahjalal University of Science and Technology, Department of Statistics, Sylhet, Bangladesh
| | - Edith J Liemburg
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, the Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands; University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, the Netherlands.
| | - Behrooz Z Alizadeh
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
| |
Collapse
|
5
|
Shafie S, Lee SP, Ong SBC, Wang P, Seow E, Ong HL, Chong SA, Subramaniam M. Prevalence and correlates of diabetes mellitus and dyslipidaemia in a long-stay inpatient schizophrenia population in Singapore. Singapore Med J 2018; 59:465-471. [PMID: 29430576 DOI: 10.11622/smedj.2018020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with schizophrenia have shorter life expectancy and one of the main causes of death is cardiovascular disease (CVD). Modifiable risk factors for CVD include diabetes mellitus (DM) and dyslipidaemia. This study aimed to establish: (a) the prevalence and correlates of DM and dyslipidaemia; (b) the proportion of those whose condition was well controlled; and (c) the incidence of undiagnosed DM and dyslipidaemia in a long-stay inpatient schizophrenia population. METHODS Data was collected to assess the physical health status of 110 inpatients with schizophrenia who had been in hospital for over one year. Information on sociodemographic characteristics, diagnosis of physical and mental illnesses, and current medications was obtained from their medical records. The overall prevalence of DM and dyslipidaemia was based on diagnosis in the medical records, current medications and fasting blood test results. RESULTS The patient group was predominantly male (85.5%), with a mean age of 55.9 ± 9.9 (range 25-90) years. Overall prevalence of DM and dyslipidaemia was 19.1% and 62.7%, respectively. Multivariate logistic regression analysis showed that Malay (odds ratio [OR] 14.97) and Indian (OR 25.71) patients were significantly more likely to have DM when compared to Chinese patients. CONCLUSION In comparison to the general population, the prevalence of DM and dyslipidaemia was found to be higher in inpatients with schizophrenia. However, the two chronic illnesses were well controlled in inpatients and few were undiagnosed, perhaps due to the regular monitoring, supervised diet and regular physical activities arranged for inpatients in the long-stay inpatient wards.
Collapse
Affiliation(s)
- Saleha Shafie
- Research Division, Institute of Mental Health, Singapore
| | - Siau Pheng Lee
- Research Division, Institute of Mental Health, Singapore
| | | | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore
| | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore
| | - Hui Lin Ong
- Research Division, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | |
Collapse
|
6
|
Clark LA, Cuthbert B, Lewis-Fernández R, Narrow WE, Reed GM. Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC). Psychol Sci Public Interest 2017; 18:72-145. [DOI: 10.1177/1529100617727266] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The diagnosis of mental disorder initially appears relatively straightforward: Patients present with symptoms or visible signs of illness; health professionals make diagnoses based primarily on these symptoms and signs; and they prescribe medication, psychotherapy, or both, accordingly. However, despite a dramatic expansion of knowledge about mental disorders during the past half century, understanding of their components and processes remains rudimentary. We provide histories and descriptions of three systems with different purposes relevant to understanding and classifying mental disorder. Two major diagnostic manuals—the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders—provide classification systems relevant to public health, clinical diagnosis, service provision, and specific research applications, the former internationally and the latter primarily for the United States. In contrast, the National Institute of Mental Health’s Research Domain Criteria provides a framework that emphasizes integration of basic behavioral and neuroscience research to deepen the understanding of mental disorder. We identify four key issues that present challenges to understanding and classifying mental disorder: etiology, including the multiple causality of mental disorder; whether the relevant phenomena are discrete categories or dimensions; thresholds, which set the boundaries between disorder and nondisorder; and comorbidity, the fact that individuals with mental illness often meet diagnostic requirements for multiple conditions. We discuss how the three systems’ approaches to these key issues correspond or diverge as a result of their different histories, purposes, and constituencies. Although the systems have varying degrees of overlap and distinguishing features, they share the goal of reducing the burden of suffering due to mental disorder.
Collapse
Affiliation(s)
| | - Bruce Cuthbert
- Research Domain Criteria Unit, National Institute of Mental Health
| | | | - William E. Narrow
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine
| | - Geoffrey M. Reed
- Department of Mental Health and Substance Abuse, World Health Organization
- Global Mental Health Program, Columbia University Medical Center
| |
Collapse
|
7
|
Roberts E, Jones L, Blackman A, Dewhurst T, Matcham F, Kan C, Mustafa O, Thomas T, Siddiqi N, Ismail K, Price H. The prevalence of diabetes mellitus and abnormal glucose metabolism in the inpatient psychiatric setting: A systematic review and meta-analysis. Gen Hosp Psychiatry 2017; 45:76-84. [PMID: 28274344 DOI: 10.1016/j.genhosppsych.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/24/2016] [Accepted: 01/08/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To systematically determine the prevalence of diabetes mellitus (DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT) in psychiatric inpatients and explore the impact of patient and study variables on prevalence estimates. METHOD We searched EMBASE, PsychINFO, Medline and CENTRAL from database inception until 1st December 2015. We included studies of any design reporting prevalence of abnormal glucose metabolism in any adult psychiatric inpatients. We conducted a random effects meta-analysis to generate pooled prevalence estimates. Chi-square tests compared differences within categorical variables (inpatient setting, continent of study and patient diagnostic category) and Spearman's correlation analyses assessed the impact of linear variables (age, year of data collection and study quality). Study quality was assessed using an adapted Newcastle-Ottawa Scale. RESULTS 36 study reports representing 42 unique cohorts were included. Across all studies prevalence of unspecified type DM was 10% (95%CI: 9-12), of T1DM was 1% (0-1), of T2DM was 9% (6-13), of IFG 18% (8-28), and of IGT was 22% (16-28). These estimates were not affected by study quality. CONCLUSIONS All estimates are higher compared to the general population. Mental health professionals should be aware of this elevated prevalence to improve screening and management of abnormal glucose metabolism.
Collapse
Affiliation(s)
- Emmert Roberts
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Leah Jones
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Alexandra Blackman
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Thomas Dewhurst
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Carol Kan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Omar Mustafa
- Department of Diabetes, King's College Hospital, Denmark Hill, London, UK
| | | | - Najma Siddiqi
- Health Sciences, University of York, Hull York Medical School, York, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Hermione Price
- West Hampshire Community Diabetes Service, Southern Health NHS Foundation Trust, Pikes Hill, Lyndhurst, UK
| |
Collapse
|
8
|
Li Y, Su R, Xu S, Huang Q, Xu H. Artesunate prevents rats from the clozapine-induced hepatic steatosis and elevation in plasma triglycerides. Neuropsychiatr Dis Treat 2017; 13:2477-2487. [PMID: 29026311 PMCID: PMC5627760 DOI: 10.2147/ndt.s145069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Clozapine is an atypical antipsychotic with therapeutic efficacy in treatment-resistant schizophrenia patients and low incidence of extrapyramidal side effects. However, the use of clozapine has been limited by its adverse effects on metabolism. Artesunate is a semisynthetic derivative of artemisinin and was shown to decrease the plasma cholesterol and triglyceride in rabbits and rats in recent studies. The aim of this study was to examine possible effects of artesunate on the clozapine-induced metabolic alterations in rats given saline, clozapine, artesunate, or clozapine plus artesunate for 6 weeks. The clozapine group showed significantly high plasma levels of triglyceride, hepatic steatosis, and fibrosis along with high levels of C-reactive protein, alanine aminotransferase, and aspartate aminotransferase compared to the saline group. But the treatment had no effect on weight gain and caused no hyperglycemia, hyperinsulinemia, and behavioral changes in the rats. More significantly, these clozapine-induced changes were not seen in rats coadministered with clozapine plus artesunate. These results added evidence supporting psychiatrists to try add-on treatment of artesunate in schizophrenia patients to ameliorate clozapine-induced adverse metabolic effects.
Collapse
Affiliation(s)
- Yanmei Li
- The Mental Health Center, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
- Department of Anatomy, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Ruibing Su
- Department of Forensics and Pathology, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Shuqin Xu
- Department of Anatomy, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Qingjun Huang
- The Mental Health Center, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Haiyun Xu
- The Mental Health Center, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
- Department of Anatomy, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
- Correspondence: Haiyun Xu, The Mental Health Center, Shantou University Medical College, 515041 Shantou, Guangdong Province, People’s Republic of China, Email
| |
Collapse
|