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Perspectives

Diabetes and mental illness: challenges and practical progress

Katherine Samaras

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Abstract

Severe mental illnesses are associated with premature death and accelerated cardiometabolic disease. Diabetes contributes substantially to the health burden in severe mental illness, with glycaemic, lipid and hypertension control often below the targets accepted as standard of care. Treatment disparities and unmet health needs are common and contribute to poorer health outcomes.

Key Points

  • Diabetes and prediabetes are common in patients with severe mental illness.
  • Screening for diabetes with measurement of fasting glucose levels and/or HbA1c should be undertaken every six months in people with severe mental illness. If weight gain occurs in this group, lifestyle strategies to prevent diabetes should be undertaken, with support and follow up.
  • People with severe mental illness and diabetes should be considered as a ‘special needs’ group, requiring longer, more frequent appointments, and regular follow up with medical and allied health professionals.
  • Assumptions should not be made about a patient’s healthy behaviour literacy, access to healthy food and food preparation facilities, and knowledge and skill sets necessary to prepare healthy meals. People with severe mental illness and diabetes may require supported training in these areas.
  • Disparities in diabetes health service delivery are well documented. Addressing these disparities is necessary to ameliorate the premature morbidity and mortality experienced by people with severe mental illness.

    Picture credit: © Phanie/Garo/Diomedia.com. Model used for illustrative purposes only.

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