Mental Health

Adequate control of HbA1c in individuals with SMI and diabetes mellitus (ages 75-84)

Individuals with adequate control of HbA1c (numerator) among individuals 18-84 years old with SMI and diabetes mellitus who had at least one documentation of HbA1c-levels in the measurement year (denominator)

Rational:

Severe mental illness (SMI) includes schizophrenia, schizoaffective disorders, and bi-polar disorders. Individuals with SMI are at a higher risk of poor physical health and of premature death. It is estimated that for people with SMI, two out of three deaths are from physical illnesses that can be prevented [1]. Cardiovascular disease and cardiovascular risk factors are more common in people with SMI compared with the general population. For instance, the prevalence of obesity is 1.5-2 fold higher in persons with SMI compared with the general population, and the prevalence of diabetes is 2-3 times higher. Additionally, the age of diabetes onset is earlier in persons with SMI, and the incidence and severity of complications are higher as well, including micro- and macro-vascular complications, acute metabolic dysregulation, and diabetes-associated mortality. The underlying mechanisms relating cardiovascular risk factors and SMI are complex, and include genetic, environmental, and behavioral aspects, as well as aspects related to anti-psychotic drug therapy [2].

Numerator:

Individuals in the denominator achieving glycemic control, according to their last hemoglobin A1c level in the measurement year: <= 7% among 18-74 years-old patients who were diabetics for less than 10 years; < =8% among 18-74 years-old patients who were diabetics for at least 10 years; <= 8% among 75-84 years-old patients.

Denominator

Individuals 18-84 years old with SMI and diabetes mellitus who had at least one documentation of HbA1c-levels in the measurement year

Notes:

None

Notes:

[1] Severe mental illness (SMI) and physical health inequalities: briefing. Public Heath England, September 2018. Available at: https://www.gov.uk/government/publications/severe-mental-illness-smi-physical-health-inequalities/severe-mental-illness-and-physical-health-inequalities-briefing
[2] Holt RI, Mitchell AJ, Diabetes mellitus and severe mental illness: mechanisms and clinical implications. Nat Rev Endocrinol. 2015 Feb;11(2):79-89

Results:
Adequate control of HbA1c by year
Adequate control of HbA1c by socio-economic position (1-lowest, 4-highest) and sex


National Program for Quality Indicators in Community Healthcare
התכנית הלאומית למדדי איכות לרפואת הקהילה בישראל