Incidence, Prevalence, and Surveillance

for Diabetes In New York State

Psychiatric Hospitals, 1997-2004
Leslie Citrome, MD, MPH, Ari Jaffe, MD, Jerome Levine, MD, David Martello
Nathan S Kline Institute for Psychiatric Research, Orangeburg, NY
New York University School of Medicine, New York City, NY
Abstract Results Discussion

Objectives: To describe the incidence of newly treated diabetes

• Incidence and prevalence has risen among inpatients
mellitus, prevalence of identified cases of diabetes mellitus, and PREVALENCE OF DM
surveillance for new cases of diabetes mellitus over the period Receiving an Antidiabetic Agent OR Diagnosis of DM hospitalized within New York State psychiatric facilities,
1997 to 2004 among inpatients in a large state psychiatric All Unique Civil Adult Inpatients, New York State Office of Mental Health
and is greater than what is observed among the general
hospital system. OMH BRFSS NYS
population in New York State, especially for those aged
Methods: Prevalence of diabetes mellitus was determined by 16% 18-44 years:
ascertaining the number of individuals receiving antidiabetic 14% COMPARISON OF PREVALENCE OF DM (2003)
medication and/or having a diagnosis of diabetes mellitus for each N=1079 / 7420
NEW YORK PSYCHIATRIC HOSPITAL POPULATION vs
12% NEW YORK GENERAL POPULATION
calendar year, using a database containing diagnostic and drug
Psychiatric Hospitals General Population
prescription information from the in-patient facilities operated by 10%
20%
the New York State Office of Mental Health. Yearly incidence was 8% 18%

calculated by identifying unique patients who received new N=696 / 10091 16%

prescriptions of antidiabetic medication among patients with no 6% GENERAL NYS POPULATION AS ESTIMATED
USING THE BEHAVIORAL RISK FACTOR
14%
SURVEILLANCE SYSTEM
12%

known prior history of receiving an antidiabetic medication nor 4% 10%

8%
having a recorded diagnosis of diabetes mellitus. Data was 2% 6%

categorized by calendar year, gender, age, race/ethnicity, and 4%

2%
psychiatric diagnosis, and relative risk ratios were calculated. 0% 0%
ALL M F 18-44 45-64 65 W B H
Surveillance for abnormal plasma glucose levels was measured 1997 1998 1999 2000 2001 2002 2003 2004
by calculating the number of plasma glucose tests completed per • Increasing age, being female, and being of non-white
100 patient-days among patients without diabetes mellitus.
race/ethnicity confers additional risk among patients
Results: Prevalence of identified cases of diabetes mellitus RISE IN PREVALENCE IS CONSISTENT hospitalized within the psychiatric facilities.
increased from 6.9% of 10,091 patients in 1997 to 14.5% of 7,420 Age, Gender, Ethnicity, Diagnosis
• This rise corresponds in time to the continued adoption
All Unique Civil Adult Inpatients, New York State Office of Mental Health

patients in 2004 (risk ratio comparing 2004 to 1997 2.11, 95% 20% 20%

confidence interval 1.93-2.31). The incidence of newly treated

15%
18-44 years 45-64 years 65+ years
15%
White Black Hispanic of second-generation antipsychotics and increased use
diabetes mellitus increased from 0.9% in 1997 to 1.8% in 2004 of antipsychotic polypharmacy.
(risk ratio of 2.03 (1.51-2.73)). The increase in incidence of newly- 10% 10%

treated cases and prevalence of identified diabetes was only • This rise also corresponds in time to revisions to the
5% 5%
partially explained by the increase in surveillance for new cases, AGE ETHNICITY plasma glucose thresholds for diagnosis of DM, an
0%
which increased from 1.23 plasma glucose tests per 100 patient-
1997 1998 1999 2000 2001 2002 2003 2004
0%
1997 1998 1999 2000 2001 2002 2003 2004
increase in rates of routine plasma glucose testing, and
days in 1997 to 1.80 in 2002 (risk ratio of 1.46 (1.43-1.50)). a greater awareness of risk factors.
20% 20%
Conclusions: The doubling of the treated incidence rate and the Men Women Schizophrenia or Schizoaffective Disorder Majo r Depressio n or Bipolar Disorder Other
• Limitations
15% 15%
rise in prevalence of identified cases of diabetes mellitus among • Retrospective collection of data and underestimation of actual
psychiatric inpatients mirrors the rise observed in the general 10% 10% prevalence.
population, but with higher absolute rates. 5% •Lack of consistent recording of comorbid medical conditions.
5%
GENDER DIAGNOSIS •Patients treated with diet and exercise only will be missed if they do
0% 0% not have a recorded diagnosis of DM.
1997 1998 1999 2000 2001 2002 2003 2004 1997 1998 1999 2000 2001 2002 2003 2004 • Incident rates may be overestimated because of incomplete
ascertainment of prior history of DM.
• Lack of information on risk factors such as family history, weight,
and level of physical activity – did the frequency of these change?
Methods INCIDENCE OF DM • Comparison with the NY general population is somewhat
Length of Stay > 30 Days, Start Date of Antidiabetic Agent > 30 Days After Admission,
and NO PRIOR HISTORY OF DIAGNOSIS OF DM OR PRIOR PRESCRIPTION OF AN
ANTIDIABETIC AGENT
speculative – the general population was polled by telephone if they
All Unique Civil Adult Inpatients, New York State Office of Mental Health had been treated for DM and hence subject to underreporting.
•Data was collected using the Integrated Research Database Men Women • Generalizability may be limited to similar chronically mentally ill
(IRDB) created by the Information Sciences Division of the inpatient populations.
Nathan S. Kline Institute for Psychiatric Research. 2.5%

•The IRDB contains patient information (demographic 2.0%

characteristics, dates of admission/transfer/discharge, and
diagnosis), and drug prescription information for every in- 1.5%
patient within the seventeen adult civil facilities of the New 1.0%
York State psychiatric hospital system.
•These psychiatric centers provide intermediate and long- 0.5%
term care to patients who are severely and persistently
0.0%
mentally ill (approximately half of the patients have a length
1997 1998 1999 2000 2001 2002 2003 2004
of stay exceeding one year). CHANGE in ADA CHANGE in WHO In press in Psychiatric Services. For
copies, please e-mail
Diagnostic Criteria Diagnostic Criteria

•Cases were defined as those who had received prescriptions citrome@nki.rfmh.org

of antidiabetic medication as documented in the IRDB or if
they had a recorded diagnosis of diabetes mellitus (ICD-9 SURVEILLANCE FOR NEW CASES OF DM
NO PRIOR HISTORY OF DIAGNOSIS OF DM OR PRIOR PRESCRIPTION OF AN ANTIDIABETIC AGENT
code of 250.xx) in the IRDB. Number of plasma glucose tests per 100 patient-days
• Incident cases were defined as having a new prescription for Admitted During Year
an antidiabetic, i.e., we excluded patients from being Admitted Prior Year but Discharged During Year
Admitted Prior Year and Not Discharged
considered as an incident case if they had been prescribed an TOTAL
antidiabetic at any time in the past back to January 1, 1994 2.50
(the earliest date where such data was available), as
documented in the IRDB. 2.00

• Patients were also excluded from the calculation of incident

1.50
cases if they ever had a recorded diagnosis of diabetes
mellitus. 1.00
• In order to reduce the possibility that a prescription of an
antidiabetic was a renewal of a medication received prior to 0.50

hospitalization, incident cases were required to have at least

0.00
a 30 day period of hospitalization prior to the start of the 1997 1998 1999 2000 2001 2002
prescription of the antidiabetic.