HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register
Objectives To investigate factors associated with the recording of glycated haemoglobin (HbA1c) in people with first diagnoses of serious mental illness (SMI) in a large mental healthcare provider, and factors associated with HbA1c levels, when recorded. To our knowledge this is the first such inves...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/7/e069635.full |
| _version_ | 1827172110765654016 |
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| author | Robert Stewart Brendon Stubbs Gayan Perera David Chandran Fiona Gaughran Nikeysha Bell |
| author_facet | Robert Stewart Brendon Stubbs Gayan Perera David Chandran Fiona Gaughran Nikeysha Bell |
| author_sort | Robert Stewart |
| collection | DOAJ |
| description | Objectives To investigate factors associated with the recording of glycated haemoglobin (HbA1c) in people with first diagnoses of serious mental illness (SMI) in a large mental healthcare provider, and factors associated with HbA1c levels, when recorded. To our knowledge this is the first such investigation, although attention to dysglycaemia in SMI is an increasing priority in mental healthcare.Design The study was primarily descriptive in nature, seeking to ascertain the frequency of HbA1c recording in the mental healthcare sector for people following first SMI diagnosis.Settings A large mental healthcare provider, the South London and Maudsley National Health Service Trust.Participants Using electronic mental health records data, we ascertained patients with first SMI diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder) from 2008 to 2018.Outcome measures Recording or not of HbA1c level was ascertained from routine local laboratory data and supplemented by a natural language processing (NLP) algorithm for extracting recorded values in text fields (precision 0.89%, recall 0.93%). Age, gender, ethnic group, year of diagnosis, and SMI diagnosis were investigated as covariates in relation to recording or not of HbA1c and first recorded levels.Results Of 21 462 patients in the sample (6546 bipolar disorder; 14 916 schizophrenia or schizoaffective disorder; mean age 38.8 years, 49% female), 4106 (19.1%) had at least one HbA1c result recorded from laboratory data, increasing to 6901 (32.2%) following NLP. HbA1c recording was independently more likely in non-white ethnic groups (black compared with white: OR 2.45, 95% CI 2.29 to 2.62), and was negatively associated with age (OR per year increase 0.93, 0.92–0.95), female gender (0.83, 0.78–0.88) and bipolar disorder (0.49, 0.45–0.52).Conclusions Over a 10-year period, relatively low level of recording of HbA1c was observed, although this has increased over time and ascertainment was increased with text extraction. It remains important to improve the routine monitoring of dysglycaemia in these at-risk disorders. |
| first_indexed | 2024-03-12T15:30:48Z |
| format | Article |
| id | doaj.art-b6dbeb22fece49be874a1c80bd97b4a5 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-03-21T03:18:33Z |
| publishDate | 2023-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-b6dbeb22fece49be874a1c80bd97b4a52024-08-01T10:15:09ZengBMJ Publishing GroupBMJ Open2044-60552023-07-0113710.1136/bmjopen-2022-069635HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case registerRobert Stewart0Brendon Stubbs1Gayan Perera2David Chandran3Fiona Gaughran4Nikeysha Bell5Department of Psychological Medicine, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UKDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UKPsychological Medicine, King’s College London Institute of Psychiatry, Psychology and Neuroscience, London, UKPsychological Medicine, King’s College London Institute of Psychiatry, Psychology and Neuroscience, London, UKInstitute of Psychiatry, Psychology and Neuroscience, Psychosis Studies, King’s College London, London, UKPsychological Medicine, King’s College London Institute of Psychiatry, Psychology and Neuroscience, London, UKObjectives To investigate factors associated with the recording of glycated haemoglobin (HbA1c) in people with first diagnoses of serious mental illness (SMI) in a large mental healthcare provider, and factors associated with HbA1c levels, when recorded. To our knowledge this is the first such investigation, although attention to dysglycaemia in SMI is an increasing priority in mental healthcare.Design The study was primarily descriptive in nature, seeking to ascertain the frequency of HbA1c recording in the mental healthcare sector for people following first SMI diagnosis.Settings A large mental healthcare provider, the South London and Maudsley National Health Service Trust.Participants Using electronic mental health records data, we ascertained patients with first SMI diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder) from 2008 to 2018.Outcome measures Recording or not of HbA1c level was ascertained from routine local laboratory data and supplemented by a natural language processing (NLP) algorithm for extracting recorded values in text fields (precision 0.89%, recall 0.93%). Age, gender, ethnic group, year of diagnosis, and SMI diagnosis were investigated as covariates in relation to recording or not of HbA1c and first recorded levels.Results Of 21 462 patients in the sample (6546 bipolar disorder; 14 916 schizophrenia or schizoaffective disorder; mean age 38.8 years, 49% female), 4106 (19.1%) had at least one HbA1c result recorded from laboratory data, increasing to 6901 (32.2%) following NLP. HbA1c recording was independently more likely in non-white ethnic groups (black compared with white: OR 2.45, 95% CI 2.29 to 2.62), and was negatively associated with age (OR per year increase 0.93, 0.92–0.95), female gender (0.83, 0.78–0.88) and bipolar disorder (0.49, 0.45–0.52).Conclusions Over a 10-year period, relatively low level of recording of HbA1c was observed, although this has increased over time and ascertainment was increased with text extraction. It remains important to improve the routine monitoring of dysglycaemia in these at-risk disorders.https://bmjopen.bmj.com/content/13/7/e069635.full |
| spellingShingle | Robert Stewart Brendon Stubbs Gayan Perera David Chandran Fiona Gaughran Nikeysha Bell HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register BMJ Open |
| title | HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register |
| title_full | HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register |
| title_fullStr | HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register |
| title_full_unstemmed | HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register |
| title_short | HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register |
| title_sort | hba1c recording in patients following a first diagnosis of serious mental illness the south london and maudsley biomedical research centre case register |
| url | https://bmjopen.bmj.com/content/13/7/e069635.full |
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