Incidence and Prevalence of Diabetes Mellitus Among Inpatients

In State-Operated Psychiatric Hospitals in New York State 1997-2004

Leslie Citrome, MD, MPH, Ari Jaffe, MD, Jerome Levine, MD, David Martello
Nathan S Kline Institute for Psychiatric Research
New York University School of Medicine
Abstract •Cases were defined as those who had received prescriptions of INCIDENCE OF DM
Length of Stay > 30 Days, Start Date of Antidiabetic Agent > 30 Days After Admission, and NO PRIOR HISTORY OF
antidiabetic medication as documented in the IRDB or if they had a DIAGNOSIS OF DM OR PRIOR PRESCRIPTION OF AN ANTIDIABETIC AGENT
All Unique Civil Adult Inpatients, New York State Office of Mental Health
Objectives: To describe the incidence of newly treated diabetes mellitus, prevalence of
identified cases of diabetes mellitus, and surveillance for new cases of diabetes mellitus
recorded diagnosis of diabetes mellitus (ICD-9 code of 250.xx) in the IRDB. Men Women

over the period 1997 to 2004 among inpatients in a large state psychiatric hospital • Incident cases were defined as having a new prescription for an 2.5%

system. antidiabetic, i.e., we excluded patients from being considered as an incident 2.0%

case if they had been prescribed an antidiabetic at any time in the past back 1.5%
Methods: Prevalence of diabetes mellitus was determined by ascertaining the number of
individuals receiving antidiabetic medication and/or having a diagnosis of diabetes to January 1, 1994 (the earliest date where such data was available), as 1.0%

mellitus for each calendar year, using a database containing diagnostic and drug documented in the IRDB. 0.5%
prescription information from the in-patient facilities operated by the New York State • Patients were also excluded from the calculation of incident cases if they 0.0%
Office of Mental Health. Yearly incidence was calculated by identifying unique patients ever had a recorded diagnosis of diabetes mellitus. 1997 1998 1999 2000 2001 2002 2003 2004
who received new prescriptions of antidiabetic medication among patients with no known • In order to reduce the possibility that a prescription of an antidiabetic was CHANGE in ADA Diagnostic Criteria CHANGE in WHO Diagnostic Criteria

prior history of receiving an antidiabetic medication nor having a recorded diagnosis of

a renewal of a medication received prior to hospitalization, incident cases
diabetes mellitus. Data was categorized by calendar year, gender, age, race/ethnicity,
and psychiatric diagnosis, and relative risk ratios were calculated. Surveillance for were required to have at least a 30 day period of hospitalization prior to the
abnormal plasma glucose levels was measured by calculating the number of plasma start of the prescription of the antidiabetic. SURVEILLANCE FOR NEW CASES OF DM
NO PRIOR HISTORY OF DIAGNOSIS OF DM OR PRIOR PRESCRIPTION OF AN ANTIDIABETIC AGENT
glucose tests completed per 100 patient-days among patients without diabetes mellitus.
Number of plasma glucose tests per 100 patient-days
Results: Prevalence of identified cases of diabetes mellitus increased from 6.9% of Admitted During Year
Admitted Prior Year but Discharged During Year
10,091 patients in 1997 to 14.5% of 7,420 patients in 2004 (risk ratio comparing 2004 to
Results Admitted Prior Year and Not Discharged
TOTAL
1997 2.11, 95% confidence interval 1.93-2.31). The incidence of newly treated diabetes 2.50
mellitus increased from 0.9% in 1997 to 1.8% in 2004 (risk ratio of 2.03 (1.51-2.73)). The
increase in incidence of newly-treated cases and prevalence of identified diabetes was PREVALENCE OF DM 2.00

Receiving an Antidiabetic Agent OR Diagnosis of DM

only partially explained by the increase in surveillance for new cases, which increased All Unique Civil Adult Inpatients, New York State Office of Mental Health
1.50

from 1.23 plasma glucose tests per 100 patient-days in 1997 to 1.80 in 2002 (risk ratio of OMH BRFSS NYS 1.00

1.46 (1.43-1.50)). 16% 0.50

14%
Conclusions: The doubling of the treated incidence rate and the rise in prevalence of 12%
N=1079 / 7420 0.00
1997 1998 1999 2000 2001 2002
identified cases of diabetes mellitus among psychiatric inpatients mirrors the rise 10%
observed in the general population, but with higher absolute rates. 8%
N=696 / 10091

6% GENERAL NYS POPULATION AS ESTIMATED USING THE

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM
4%
2% Discussion
Methods 0%
1997 1998 1999 2000 2001 2002 2003 2004
• Incidence and prevalence has risen among inpatients hospitalized within
•Data was collected using the Integrated Research Database (IRDB) New York State psychiatric facilities, and is greater than what is observed
created by the Information Sciences Division of the Nathan S. Kline Institute RISE IN PREVALENCE IS CONSISTENT among the general population in New York State, especially for those aged
Age, Gender, Ethnicity, Diagnosis
for Psychiatric Research. 20%
All Unique Civil Adult Inpatients, New York State Office of Mental Health
20%
18-44 years.
•The IRDB contains patient information (demographic characteristics, dates
18-44 years 45-64 years 65+ years
White Black Hispanic
15% 15%
• Increasing age, being female, and being of non-white race/ethnicity
of admission/transfer/discharge, and diagnosis), and drug prescription 10% 10%

confers additional risk among patients hospitalized within the psychiatric

information for every in-patient within the seventeen adult civil facilities of
5% 5%

0%
AGE 0%
ETHNICITY facilities.
the New York State psychiatric hospital system. 1997 1998 1999 2000 2001 2002 2003 2004 1997 1998 1999 2000 2001 2002 2003 2004

•These psychiatric centers provide intermediate and long-term care to

20%
Men Women
20%
Schizophrenia or Schizoaffective Disorder Major Depression or Bipolar Disorder Other • This rise corresponds in time to the continued adoption of second-
15% 15%

patients who are severely and persistently mentally ill (approximately half of 10% 10%
generation antipsychotics, increased use of antipsychotic polypharmacy,
the patients have a length of stay exceeding one year). 5% 5% and a decrease in the bed capacity of the hospital system, as well as
GENDER DIAGNOSIS
0% 0% revisions to the plasma glucose thresholds for diagnosis of DM, an increase
1997 1998 1999 2000 2001 2002 2003 2004 1997 1998 1999 2000 2001 2002 2003 2004
in rates of routine plasma glucose testing, and a greater awareness of risk
In press in Psychiatric Services. For copies, please e-mail citrome@nki.rfmh.org factors.