(PO-136) The relationship between glycemic control and food insecurity in people with diabetes mellitus and comorbid psychosis
Background/Significance: In the US, adults with psychosis have increased mortality mostly due to cardiovascular disease (CVD) (Olfson 2015). Diabetes mellitus (DM) is a potent CVD risk factor, which occurs in 28% of individuals with serious mental illnesses (Mangurian 2018). Little is understood of the contribution of social and environmental factors to diabetes health disparities experienced by people with psychosis. Food insecurity has been shown to be an independent risk factor for poor glycemic control (Seligman 2012).
Methods: This IRB-approved cross-sectional survey aims to describe the prevalence and correlates of food insecurity among adults with DM and co-morbid psychosis who receive primary care through 13 clinics affiliated with a large academic healthcare system in Washington state. Administrative data was utilized to identify eligible patients: age 18-65; one inpatient or two outpatient diagnoses of schizophrenia (F20-29) or bipolar disorder (F31) and one inpatient or two outpatient diagnoses of type 2 DM (E08-E13.9). Patients with diagnoses of dementia or intellectual disability were excluded. All eligible patients were sent a letter with a unique link to a survey in Research Electronic Data Capture. The survey included questions related to diabetes clinical characteristics, self-care behaviors, and psychosis symptom severity in addition to demographics. Food insecurity was measured with the validated USDA’s Food Security Survey Module. Consistent with previous studies, participants will be considered food-insecure if two or more responses are affirmative. We will compare clinical and demographic characteristics of participants who are food insecure with those who are not using χ2 for categorical variables and t tests for continuous variables.
Results: 624 patients with diabetes and psychosis were identified. 434 surveys have been sent to date, and 103 patients have completed the survey, for a response rate of 23.7%. 52% of respondents to date are female, 30.5% are non-white, and 70.9% have a diagnosis of bipolar disorder. 50% of this preliminary sample reported no current employment and 42% were receiving food assistance.
Discussion: Survey data collection will end April 30 and analyses will be completed in May-June. Given the well-established link between poverty and serious mental illness, this study may increase understanding about the contribution of food insecurity to poor diabetes disease control among adults with diabetes and co-morbid psychosis.
Conclusion/Implications: Gaining a greater understanding of the overlap of psychosis, diabetes mellitus, and food insecurity can inform effective interventions that seek to reduce the cardiovascular health disparities.
Mangurian CV et al. Diabetes and prediabetes prevalence by race and ethnicity. Diabetes care. 2018 Jul 1;41(7):e119-20.
Olfson M et al. Premature mortality among adults with schizophrenia in the United States. JAMA psychiatry. 2015 Dec 1;72(12):1172-81.
Seligman HK et al. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes care. 2012 Feb 1;35(2):233-8.
Gaining a greater understanding of the overlap of psychosis, diabetes mellitus, and food insecurity