Quality of Diabetes Care for Individuals with Comorbid Chronic Psychotic Illness: A Sex-Based Analysis

Background: Diabetes is common among individuals with chronic psychotic illness, yet they receive lower quality of diabetes care than those without psychosis. Men usually receive higher quality diabetes care than women, but whether this holds true in chronic psychotic illness populations is unknown. We aimed to determine whether quality of diabetes care differs between men and women with chronic psychotic illness. Methods: This population-based cohort study used Ontario health administrative data to compare women and men with comorbid chronic psychotic illness and diabetes mellitus (2011-2013). The primary outcome was adherence to diabetes monitoring guidelines, defined as 1 retinal exam, 4 hemoglobin A1c (HbA1c) tests, and 1 dyslipidemia test during a 2-year period. Logistic regression models compared women to men to generate adjusted odds ratios (aOR) and confidence intervals (95% CI), adjusting for potential confounding variables. Results: Women with chronic psychotic illness (n=13,972) were slightly more likely to receive guideline-adherent diabetes monitoring than men (n=12,287) (25.2% vs. 23.0%; aOR 1.20, 95% CI 1.10-1.30), including a greater likelihood of receiving 1 retinal exam (aOR 1.13, 95% CI 1.08-1.19) and 4 HbA1c tests (aOR 1.06, 95% CI 1.01-1.12). There was no difference in receipt of 1 dyslipidemia test (aOR 1.04, 95% CI 0.99-1.11). Conclusions: Quality of diabetes monitoring is similarly poor in women and men with chronic psychotic illness, with women receiving only marginally more optimal monitoring than men. This differs from patterns in the general population, and could have implications when designing and implementing interventions to improve diabetes care in women and men with chronic psychotic illness.