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

Med Care. 2004 Dec;42(12):1167-75. doi: 10.1097/00005650-200412000-00003.


Objectives: We sought to determine whether receipt of the American Diabetes Association's recommended clinical services was similar among insured subjects with and without mental disorders during the period of 1996 to 2001.

Research design: Our study was a retrospective analysis of Blue Cross/Blue Shield of Iowa administrative claims data, 1996-2001.

Subjects: We studied 26,020 adults with diabetes; 6,627 (25%) had a coexisting mental disorder.

Measures: Service receipt included hemoglobin A1c (HbA1c) testing, dilated eye examination, cholesterol measurement, and urine protein testing. We used Cox regression to calculate hazard ratios (HRs) for service receipt after adjusting for demographic, disease, and utilization factors.

Results: Mental disorder subjects were more likely to be younger, women, urban residents, have diabetes complications and comorbidity, and to have increased healthcare utilization. Although they received more services (mean, 2.6) than subjects without mental disorders (mean, 2.3), they were less likely to have received a HbA1c test (HR 0.92; 99.9% confidence interval [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 mental disorder categorization. Few subjects (< 6%) strictly adhered to the guidelines of the American Diabetes Association.

Conclusions: Receipt of clinical preventive services for both populations was suboptimal. Importantly, subjects with mental disorders were more likely to have diabetic complications, even when controlling for utilization of healthcare services, possibly because of poorer receipt of HbA1c testing. Persons with mental disorders should be more aggressively educated about blood sugar control, given the high rate of complications in this population. Medical care directed at persons with comorbid medical and psychiatric disorders may be beneficial.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Blue Cross Blue Shield Insurance Plans
  • Comorbidity
  • Diabetes Complications / diagnosis*
  • Diabetes Complications / economics
  • Diabetes Complications / therapy
  • Diagnostic Services / economics
  • Diagnostic Services / standards
  • Diagnostic Services / statistics & numerical data*
  • Diagnostic Tests, Routine / economics
  • Diagnostic Tests, Routine / standards
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Iowa
  • Male
  • Mental Disorders / classification
  • Mental Disorders / complications*
  • Mental Disorders / economics
  • Middle Aged
  • Practice Guidelines as Topic
  • Proportional Hazards Models
  • Retrospective Studies