Feature Article

Diabetes and mental illness: optimising care

Tim Lambert

Figures

© deepak sethi/istockphoto.com model used for illustrative purporse only
© deepak sethi/istockphoto.com model used for illustrative purporse only

Abstract

Diabetes and serious mental illness (SMI) account for a considerable proportion of premature mortality. It is important that GPs are aware of the association between diabetes and SMI, particularly in young people, and manage patients with either or both conditions appropriately, by regular screening for potential comorbidities and involving a team of healthcare professionals to optimise patient outcomes.

Key Points

  • There is a clear association between serious mental illness (SMI) and type 2 diabetes in younger populations. It is therefore important to assess younger patients with SMI for hyperglycaemia and be alert to the symptoms of depressive and anxiety disorders in those with diabetes, even if other disorders (such as psychotic disorders) are present.
  • Patients with SMI and hyperglycaemia are considered high risk for premature mortality, and should be regularly screened for comorbidities and managed appropriately.
  • Establishing a shared care-co-ordination arrangement with a local health district mental health services, non-Governmental organisation or an identified carer, and simplifying or minimising prescriptions can help support patients adhere to treatment regimens.
  • Patients with SMI are at high risk of diabetes and cardiometabolic disorders and frequent screening is encouraged for early detection and intervention.
  • Obstructive sleep apnoea is a common comorbidity in people with SMI and should be screened for regularly as it may worsen risks for both diabetes and mental health stability.
  • The orexigenic nature of some psychotropic drugs can contribute to weight gain. Drug regimens should be reviewed and orexigenic drugs replaced where feasible, especially in cases of polypharmacy.

Figures

© deepak sethi/istockphoto.com model used for illustrative purporse only
© deepak sethi/istockphoto.com model used for illustrative purporse only