Diabetes screening and care received by the mentally ill in an integrated system

University Of California, San Francisco, San Francisco CA

Investigators

Linked publications, trials & patents

Abstract

? DESCRIPTION (provided by applicant): This application for Small Grants for New investigators to Promote Diversity in Health-Related Research (R03) will provide support for Dr. Christina Mangurian, a Latina psychiatrist at the University of California, San Francisco (UCSF), based at San Francisco General Hospital (SFGH). Dr. Mangurian will conduct research to examine diabetes screening and care received by a racially and ethnically diverse, insured population with severe mental illness served within an integrated health care delivery system. Dr. Mangurian has assembled a multidisciplinary team to facilitate her research. She has partnered with the Director of the NIDDK-funded Center for Diabetes Translational Research (CDTR), Dr. Julie Schmittdiel, based at the Kaiser Permanente Northern California Division of Research. Her UCSF Co-Investigator, Dr. Dean Schillinger, is Chief of the UCSF Division of General Internal Medicine at SFGH and has international expertise in diabetes research and health disparities. Their expertise will be complemented by Dr. Eric Vittinghoff, a UCSF biostatistician; Dr. Constance Weisner, a UCSF mental health services researcher; and two NIMH-funded collaborators with expertise in health screening among people with severe mental illness, Drs. Susan Essock and John Newcomer. People with severe mental illnesses (e.g., schizophrenia, bipolar disorder) die, on average, 25 years earlier than the general population, most often from cardiovascular disease. The antipsychotic medications used to treat this population are one major culprit because they increase the risk of diabetes and other metabolic abnormalities. Unfortunately, almost 10 years after publication of national screening guidelines, 70% of the people receiving these medications remain unscreened for diabetes and pre-diabetes. Small studies suggest minorities with severe mental illness are particularly susceptible to metabolic side effects from the antipsychotic medications, making screening of this high-risk subpopulation particularly important. Unfortunately, examination of this vulnerable population has been challenging because of the fragmentation of the physical and medical health care systems, particularly with respect to the acquisition of laboratory results. There is an urgent need to understand targets for interventions to improve the care of this vulnerable population. Therefore, in Aim 1, Dr. Mangurian proposes to determine the diabetes screening rates among a diverse population with severe mental illness who receive services at an integrated care delivery system. In Aim 2, she will estimate the prevalence of diabetes and pre-diabetes among diverse populations with severe mental illness. In Aim 3, she will determine the proportion of people with co-morbid diabetes and severe mental illness receiving evidence-based diabetes care. The results of this research will identify patient-, provider-, and system-level targets to hlp guide and design an intervention to close the diabetes screening and care gaps for minorities with severe mental illness in a subsequent R01 application.