Screening SSRI-users for diabetes in a general practice
| Date | 14 September 2015 |
| Published date | 14 September 2015 |
| DOI | https://doi.org/10.1108/MHRJ-09-2014-0037 |
| Pages | 177-184 |
| Author | Annabel Jane McDonald,Helen Towner |
| Subject Matter | Health & social care,Mental health |
Screening SSRI-users for diabetes
in a general practice
Annabel Jane McDonald and Helen Towner
Dr Annabel Jane McDonald is
Doctor at Elizabeth Raybould
House, Little Brook Hospital,
Dartford, UK.
Dr Helen Towner is GP at
Aylesford Medical Centre,
Maidstone, UK.
Abstract
Purpose –A pragmatic evaluation of the practicality of diabetes screening for users of serotonin specific
reuptake inhibitors (SSRI’s). The paper aims to discuss this issue.
Design/methodology/approach –This study audited the response of SSRI-users to personal invitation for
diabetes screening. One-third of such patients had been screened during the past year. The remaining 217
patients were invited for fasting blood glucose tests and the improvement in screening rates measured. The
rate of positive results was compared to a cohort who received fasting blood glucose screening due to
physical risk factors for diabetes.
Findings –Specific invitation increased the take-up of screening from 34 to 52 per cent of SSRI-users.
Engagement was significantly better when patients could be contacted by telephone rather than letter.
The SSRI-using cohort had a greater rate of identified diabetes than a cohort with physical risk factors
for diabetes.
Practical implications –SSRI-users are a difficult group to engagein medical screening and an assertive
approach is of value. It is likely that the physical care of these patients would be enhanced by the active
maintenanceof contact by a practice healthcare professional.Screening of SSRI-users for diabetesis justified
by both detection rateand the importance of establishing co-morbidity in terms of treatment decisions.
Originality/value –Co-morbidity of diabetes and depression has been observed to result in a poor
prognosis for the patient which can be tempered if successful engagement leads to early treatment of both
conditions with a more tailored choice of medication and care.
Keywords Primary care, Diabetes, General practice, Screening, Antidepressant, SSRI
Paper type Research paper
Introduction
Previous research suggests that there is an increased risk of diabetes associated with both
depression (Golden et al., 2008; Mezuk et al., 2008; Musselman et al., 2003; Knol et al., 2006)
and the use of antidepressants (Bhattarcharjee et al., 2013; Yoon et al., 2013). Early identification
of those patients who are co-morbid for the conditions would enable the instigation of glycaemic
control and more appropriate choice of antidepressant treatment (Joint Formulary Committee,
2013; Lustman et al., 2000; Van Reedt Dortland et al., 2010).
It is known that those with mental illness are a challenging group to engage which likely reflects a
combination of anergia with feelings of fear and worthlessness (Knapik and Graor, 2013; Rollman
et al., 2006). Community follow up care of those with depression has been observed to be weak
(Ekers et al., 2007; Kessler et al., 2005; Thombs et al., 2012; Rollman et al., 2006) which may
reflect such poor engagement with primary care professionals.
It is recommended that all patients with depression are screened for diabetes
(Taylor et al., 2012). This study examines the current rate of diabetes screening for users of
Received 26 October 2014
Revised 24 May 2015
Accepted 26 May 2015
DOI 10.1108/MHRJ-09-2014-0037 VOL. 20 NO. 3 2015, pp. 177-184, © Emerald Group Publishing Limited, ISSN 1361-9322
j
MENTALHEALTH REVIEW JOURNAL
j
PAG E 17 7
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