Supporting the lifestyle modification and treatment of type 2 diabetes for people with severe mental illness

Abstract

This review describes the association between diabetes and the two main severe mental illnesses (SMIs), schizophrenia and bipolar illness, which have been recognised for over a century. It also explains how lifestyle modification can improve outcomes. People with SMI have an increased prevalence of other metabolic comorbidities. The increase in diabetes and metabolic syndrome is a predictor of cardiovascular disease, which is the commonest cause of death in people with SMI (accounting for up to 60% of all deaths in these people). Factors contributing to risk of disease are the same in people with SMI as in the general population, but lifestyle is probably most important because this is potentially amenable to modification. Poverty, urbanisation, poor diet and physical inactivity are key risk factors for diabetes that occur more frequently in people with SMI. SMI contributes further to diabetes risk as illustrated by studies of drug-naïve first-episode patients. Antipsychotic medications have been implicated in diabetes development. The high prevalence of diabetes has a number of clinical implications for care. First, we need to screen for diabetes, as recommended by national bodies including the National Institute for Health and Clinical Excellence (NICE) and the American Diabetes Association. Secondly, we need to implement strategies to reduce the risk of diabetes. The Salford Weight Management Clinic, established in May 2000, has shown that lifestyle modification is possible in SMI. Finally, strategies should be developed to manage the health of people with SMI who develop diabetes.

Keywords:

• Severe mental illness
• schizophrenia
• antipsychotic
• diabetes