Prediabetes assessment and follow-up in older veterans with schizophrenia.
OBJECTIVE
Assess glycemic monitoring and follow-up.


METHODS
Retrospective study using administrative data (October 2001-September 2005).


METHODS
Veterans Health Administration.


METHODS
A nationwide sample of 39,226 outpatients aged 50 years or older with schizophrenia. Patients had no diagnosis or medications for diabetes at baseline.


METHODS
Hemoglobin A1c tests; blood glucose tests with same-day low-density lipoprotein to approximate fasting glucose. Glycemic tests were combined to indicate a) prediabetic dysglycemia (100-125 mg/dL proxy fasting glucose or 5.8%-6.4% hemoglobin A1c) and b) diabetic dysglycemia (≥126 proxy fasting glucose or ≥6.5% A1c).


RESULTS
Approximately one-third of patients (32%; 12,587) had proxy fasting blood glucose or A1c tests in 2002; multiple tests were rare. The proportion tested increased to 40% by 2005. Test results suggested prediabetic dysglycemia for 5,345 tested patients (42% of those tested) and diabetic dysglycemia for 1,287 tested patients (10%) at baseline. In multivariate regression models, glycemic testing was associated with dyslipidemia, hypertension, and younger age. Dysglycemia was associated with hypertension, dyslipidemia, and older age. Follow-up treatment/diagnosis of diabetes occurred for 8% of patients (11% of those tested) and was associated with baseline dysglycemia, hypertension, and younger age. Mortality (15% during the 4-year study) was higher among untested and untreated patients.


CONCLUSIONS
Dysglycemia was prevalent among older patients with schizophrenia, although monitoring and follow-up were uncommon. Follow-up treatment correlated with survival. Despite evident utility of testing, few at-risk patients with schizophrenia were adequately monitored, diagnosed, or treated for dysglycemia.
Copeland
Laurel A
LA
Veterans Affairs HSR&D, Departments of Psychiatry, University of Texas Health Science Center at San Antonio, TX, USA. LaurelACopeland@gmail.com
Parchman
Michael L
ML
Zeber
John E
JE
Lawrence
Valerie A
VA
Downs
John R
JR
Miller
Alexander L
AL
D000367:Age Factors; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D003920:Diabetes Mellitus / Q000378:metabolism / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications*; D014728:Veterans / Q000523:psychology*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human