Diabetes control in patients with severe mental illness

  • Smith R & al.
  • J Psychiatr Ment Health Nurs
  • 9 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • People with type 2 diabetes mellitus (T2DM) and severe mental illness (SMI) are more likely to have extreme values of glycated haemoglobin (HbA1c) and systolic blood pressure (SBP) that are associated with adverse outcomes.
  • T2DM patients with SMI vs those without SMI had similar average levels of cholesterol, HbA1c and diastolic blood pressure (DBP) but lower SBP.

Why this matters

  • Findings suggest that in people with both SMI and T2DM, improved management of cardiovascular risk factors in general, glycaemic control in particular, is central to addressing the risk for adverse outcomes.

Study design

  • Study used data from the UK Clinical Practice Research Datalink and analysed longitudinal clinical records of patients with T2DM (n=30,353; 657 with SMI; 29,696 controls without SMI).
  • Cardiovascular risk factors compared between SMI and controls.
  • Funding: NIHR CLAHRC Yorkshire and Humber.

Key results

  • No significant differences observed between patients with SMI and controls in the mean level of:
    • cholesterol (β=−0.05; standard error [SE]=0.05; P=.19),
    • HbA1c (β=−0.08; SE=0.05; P=.09), and
    • DBP (β=−0.30; SE=0.25; P=.21).
  • Patients with SMI had significantly lower mean SBP (β=−2.50; SE=0.44; P≤.001).
  • The risk for extreme values (high or low) of HbA1c (OR, 1.38; 95% CI, 1.18-1.64) and SBP (OR, 1.76; 95% CI, 1.40-2.21) was higher in patients with SMI and T2DM.

Limitations

  • Relatively small number of adults with comorbid SMI and diabetes.

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