Receipt of diabetes services by insured adults with and without claims for mental disorders

Purpose To determine if receipt of the American Diabetes Associationʹs (ADA) recommended clinical services differed among privately insured subjects with and without mental disorders (MD) during 1996 to 2001. Methods Service receipt included hemoglobin A1c (HbA1c) testing, dilated eye examination, cholesterol measurement, and urine protein testing. Cox regression was used to calculate hazard ratios (HR) for service receipt after adjusting for demographic, disease, Elixhauser medical comorbidity, and utilization factors. Results We identified 26,020 adults with diabetes, of whom 6627 (25%) had a coexisting MD. The MD subjects were more likely to be younger, women, urban residents, have diabetes complications and comorbidity, and have increased healthcare utilization. Although they received more services (mean = 2.6) than non-MD subjects (mean = 2.3), they were less likely to have received a HbA1c test (HR = 0.92; 99.9% CI = 0.87–0.97) and a cholesterol measurement (HR = 0.92; 99.9% CI = 0.86–0.98). Receipt of a dilated eye examination (HR = 0.96; 99.9% CI = 0.89–1.04) and urine protein test (HR = 0.98; 99.9% CI = 0.92–1.04) was similar. Service receipt varied by specific MD categorization. Few subjects (<6%) strictly adhered to ADA guidelines. Conclusion Receipt of clinical preventive services for both populations was suboptimal. Importantly, subjects with MD were more likely to have diabetic complications, even when controlling for utilization, possibly because of poorer receipt of HbA1c testing. Persons with both diabetes and MD should be more aggressively educated about blood sugar control, given the high rate of complications in this population. Medical care specifically designed for diabetic persons with comorbid medical and psychiatric disorders may be beneficial.