Medication adherence and glycemic control in patients with psychotic disorders in the Veterans Affairs healthcare system

  • Leigh A. Nelson
  • Maqual R. Graham
  • Cameron C. Lindsey
  • Rafia S. Rasu


Objective: To compare antihyperglycemic medication adherence and glycemic control between individuals with schizophrenia and related psychotic disorders and a nonpsychiatric comparison group.

Methods: This was a retrospective medical record review. A total of 124 subjects with diabetes (62 patients with schizophrenia or a related psychotic disorder and 62 randomly selected, age-matched patients without a psychiatric illness) receiving their medical and psychiatric care exclusively through the Kansas City Veterans Affairs healthcare system during 2008 were included in the study. Adherence to antihyperglycemic and antipsychotic medication was determined by refill records obtained through the computerized patient record system to calculate the cumulative mean gap ratio. Hemoglobin A1C values were utilized to compare glycemic control between groups and compared to glycemic goals established by diabetes treatment guidelines.

Results: Antihyperglycemic medication adherence was poor for both groups as approximately 60% of the psychotic disorder group and 75% of the nonpsychiatric comparison group were without antihyperglycemic medication for greater than 30 days during the 12-month period but adherence did not differ between the groups (p=0.182). Antipsychotic adherent subjects (≥80% adherent) were more likely to be adherent to their antihyperglycemic medication (p=0.0003). There were no significant differences between groups in glycemic control.

Conclusion: Antihyperglycemic medication adherence and glycemic control was less than optimal for both groups. There were no significant differences in antihyperglycemic medication adherence and glycemic control between patients with a psychotic disorder and those without a psychiatric illness.


Keywords: Medication Adherence. Diabetes Mellitus. Psychotic Disorders. Veterans. United States.


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1. Byerly MJ, Nakonezny PA, Lescouflair E. Antipsychotic medication adherence in schizophrenia. Psychiatric Clinics of North America 2007;30:437-452.

2. Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 2002;63:892-909.

3. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004;27:596-601.

4. Koranyi EK. Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinical population. Arch Gen Psychiatry 1979;36:414-419.

5. Tsuang MT, Perkins K, Simpson JC. Physical diseases in schizophrenia and affective disorders. J Clin Psychiatry 1983;44:42-46.

6. Allebeck P, Wistedt B. Mortality in schizophrenia. Arch Gen Psychiatry 1986;43:650-653.

7. Keefe RSE. Cognitive deficits in patients with schizophrenia: effects and treatment. J Clin Psychiatry 2007;68:8-13S.

8. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care 2004;27:1218-1224.

9. Cramer JA, Rosenheck R. Compliance with medication regimens for mental and physical disorders. Psychiatric Services 1998;49:196-201.

10. Dolder CR, Lacro JP, Jeste DV. Adherence to antipsychotic and nonpsychiatric medications in middle-aged and older patients with psychotic disorders. Psychosomatic Medicine 2003;65:156-162.

11. Piette JD, Heisler M, Ganoczy D, McCarthy JF, Valenstein M. Differential medication adherence among patients with schizophrenia and comorbid diabetes and hypertension. Psychiatric Services 2007;58:207-212.

12. Kreyenbuhl J, Dixon LB, McCarthy JF, Soliman S, Ignacio RV, Valenstein M. Does adherence to medications for type 2 diabetes differ between individuals with vs without schizophrenia. Schizophrenia Bulletin 2010;36:428-435.

13. Dolder CR, Furtek K, Lacro JP, Jeste DV. Antihypertensive medication adherence and blood pressure control in patients with psychotic disorders compared to persons without psychiatric illness. Psychosomatics 2005;46:135-141.

14. Sikka R, Xia F, Aubert RE. Estimating medication persistency using administrative claims data. Am J Managed Care 2005;11:449-457.

15. Steiner JF, Prchazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and application. J Clin Epidemiology 1997;50:105-116.

16. Hamilton RA, Briceland LL. Use of prescription refill records to assess patient compliance. Am J Hosp Pharm 1992;49:1691-1696.

17. Standards of Medical Care in Diabetes-2008. American Diabetes Association. Diabetes Care 2008;31:S12-S54.

18. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III) (Accessed September 23, 2008).

19. Texas Medication Algorithm Project (TMAP) A Collaborative Effort. Accessed June 3, 2010.

20. US Department of Health and Human Services, NIH-NHLBI. Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults. NIH publication no. 00-4084. Bethesda, MD: National Institutes of Health, 2000.

21. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol 1992;45:197-203.

22. Putnam KG, Buist DSM, Fishman P, Andrade SE, Boles M, Chase GA, Goodman MJ, Gurwitz JH, Platt R, Raebel MA, Arnold Chan K. Chronic disease score as a predictor of hospitalization. Epidemiology 2002;13:340-346.

23. Dolder CR, Lacro JP, Dunn LB, Jeste DV. Medication adherence: is there a difference between typical and atypical agents? Am J Psychiatry 2002;159:103-108.

24. Katon W, Russo J, Lin EHB, Heckbert SR, Karter AJ, Williams LH, Ciechanowski P, Ludman E, Von Korff M. Diabetes and poor disease control: Is comorbid depression associated with poor medication adherence or lack of treatment intensification? Psychosomatic Medicine 2009;71:965-972.

25. Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, Ciechanowski P, Ludman EJ, Bush T, Young B. Relationship of depression and diabetes self-care, medication adherence, and preventative care. Diabetes Care 2004;27:2154-2160.

26. Gonzalez JS, Safren SA, Delahanty LM, Cagliero E, Wexler DJ, Meigs JB, Grant RW. Symptoms of depression prospectively predict poorer self-care in patients with Type 2 diabetes. Diabet Med 2008;25:1102-1107.

27. Frayne SM, Halanych JH, Miller DR, Wang F, Lin H, Pogach L, Sharkansky EJ, Keane TM, Skinner KM, Rosen CS, Berlowitz DR. Disparities in diabetes care: impact of mental illness. Arch Intern Med 2005;165:2631-2638.

28. Desai MM, Rosenheck RA, Druss BG, Perlin JB. Mental disorders and quality of diabetes care in the veterans health administration. Am J Psychiatry 2002;159;1584-1590.

29. Dixon LB, Kreyenbuhl JA, Dickerson FB, Donner TW, Brown CH, Wolheiter K, Postrado L, Goldberg RW, Fang L, Marano C, Messias E. A comparison of type 2 diabetes outcomes among persons with and with severe mental illness. Psychiatr Serv 2004;55:892-900.

30. Weiss AP, Henderson DC, Weilburg JC, Goff DC, Meigs JB, Cagliero E, Grant RW. Treatment of cardiac risk factors among patients among patients with schizophrenia and diabetes. Psychiatr Serv 2006;57:1145-1152.

31. Krein SL, Bingham CR, McCarthy JF, Mitchinson A, Payes J, Valenstein M. Diabetes treatment among VA patients with comorbid serious mental illness. Psychiatr Serv 2006;57:1016-1021.

32. Whyte S, Penny C, Phelan M, Hippisley-Cox J, Majeed A. Quality of diabetes care in patients with schizophrenia and bipolar disorder: cross-sectional study. Diabet Med 2007;24:1442-1448.

33. Goldberg RW, Kreyenbuhl J, Medoff DR, Dickerson FB, Wolheiter K, Fang LJ, Brown CH, Dixon LB. Quality of diabetes care among adults with serious mental illness. Psychiaitr Serv 2007;58:536-543.

34. National Committee for Quality Assurance. The State of Health Care Quality 2009. at: (Accessed on July 2, 2010).

35. Deyo RA, Inui TS, Sullivan B. Noncompliance with arthritis drugs: magnitude, correlates, and clinical implications. J Rheumatol 1981;8:931-936.

36. Peterson GM, McLean S, Millingen KS. Determinants of patients compliance with anticonvulsant therapy. Epilepsia 1982;23:607-613.

37. Steiner JF, Koepsell TD, Fihn SD, Inui TS. A general method of compliance assessment using centralized pharmacy records. Med Care 1988;26:814-823.

38. Steiner JF, Fihn SD, Blair D, Inui TS. Appropriate reductions in compliance among well-controlled hypertensive patients. J Clin Epidemiol 1991;44:1361-1371.
How to Cite
Nelson LA, Graham MR, Lindsey CC, Rasu RS. Medication adherence and glycemic control in patients with psychotic disorders in the Veterans Affairs healthcare system. Pharm Pract (Granada) [Internet]. 2011Jun.17 [cited 2019Jul.23];9(2):57-5. Available from:
Original Research