Diabetes treatment in people with type 2 diabetes and schizophrenia: Retrospective primary care database analyses

Aims: Aim of this study were to compare outcomes (HbA1c, BMI) and antidiabetic treatment of type 2 diabetes patients with and without schizophrenia under real-life conditions in primary care practices in Germany. Methods: 1321 type 2 diabetes patients with and 1321 matched controls (age, sex, diabetes duration, diabetologist care, practice) without schizophrenia in 1072 general practices throughout Germany were retrospectively analyzed (Disease Analyser: 01/2009-12/2013). Antidiabetic treatment, HbA1c and BMI were compared using paired t-tests, McNemar tests and conditional logistic regression adjusting for macro- and microvascular comorbidity (ICD-10). Results: Mean age (+/- SD) of patients and controls was 67.4 +/- 13.2 years (males: 38.9%). Diabetes duration was 5.7 +/- 14.3 years, 6% were in diabetologist care. Private health insurance was less often found among patients with schizophrenia than controls (2.2% vs 6.3%; p < 0.0001). There was no difference in the mean HbA1c values (cases: 7.1 +/- 1.4%; controls: 7.2 +/- 1.5%) (54.1 vs. 55.2 mmol/mol) (p = 0.8797) and in the average BMI (32.4 +/- 6.6 vs. 31.0 +/- 5.0 kg/m(2); p = 0.2072) between the two groups. Novel cost-intensive antidiabetic agents (DPP-4- or SGLT2-inhibitors, GLP-1 receptor agonists) were less often prescribed in cases (15.3 vs. 18.3%; p = 0.0423). However, in multivariable logistic regression, schizophrenia (odds ratio, 95%CI: 1.101; 0.923-1.317) was not associated with prescription use of novel antidiabetic agents (reference: other antidiabetic agents) after adjusting for private health insurance (OR: 2.139; 1.441-3.177) and comorbidity. Conclusions: There is no evidence that type 2 diabetes patients with schizophrenia have worse diabetes control than those without a severe mental illness in general practices. (C) 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.