One in three mentally ill patients with diabetes can be saved
Individualised treatment plans for patients suffering from both type-2 diabetes and mental illness could reduce their mortality by 33 per cent.
Patients suffering with mental illness and type-2 diabetes tend to die much earlier than other psychiatric patients, and until now, scientists did not know why this was.
Now a pioneering new study has some answers.
The mortality of psychiatric patients with type-2 diabetes is reduced by as much as 33 per cent when doctor and patient work together closely to come up with an individualised diabetes treatment plan.
This is compared with those patients who received standard care, where the patient checks in with their doctor several times a year to measure their blood sugar, weight, blood pressure, and cholesterol.
An individualised intervention allows the patient to think about what is realistic and set future goals to be discussed at the next meeting.
"I think it's a great result and really interesting that the results are so striking,” Anne Lindhardt, a senior lecturer specialising in psychiatry at the Department of Clinical Medicine, Copenhagen University, Denmark.
“It’s a clear indication that this is the way to go if we are to help psychiatric patients with diabetes," says Lindhardt.
The results are published in the scientific journal General Hospital Psychiatry.
Need for more care
In the new study, researchers followed the progress of 1,381 patients with type-2 diabetes for 19 years. In total, 179 patients had or developed a serious mental illness during the project.
All had diabetes control consultations with their GPs who were divided into two groups. Half of the doctors gave standard treatment and the other half offered a special individualised intervention.
Lead-author, Professor Niels de Fine Olivarius, from the University of Copenhagen, Denmark, trained the doctors in how best to support their patients.
"It’s crucial that the patient and doctor sit down together and agree on targets for the treatment of their diabetes,” says Olivarius.
“I told the doctors that it’s not always about achieving the best control of the disease. The most important thing is to maintain a good and trusting relationship between the practitioner and the patient," he says.
He gave the doctors a form to complete with the patient, to rate how well the disease was being controlled. They had three options: good, acceptable, or bad.
If the patient for various reasons did not have enough energy to follow the recommendations on diet, exercise, or medication, then this would be rated as bad. This could be due to the mental illness.
According to Lindhardt, the success of the efforts with psychiatric patients could well be because these patients in particular benefit greatly from closer monitoring and inclusion in the treatment.
"It’s the personal relationship that means a lot. The fact that someone cares for them and really helps them can make a huge difference,” says Lindhardt.
“People with mental illness are not as concerned about their health as everyone else. For them it may seem like an even more insurmountable challenge to get started, and so this additional support is of great value," says Lindhardt.
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Read the Danish version of this story on Videnskab.dk
Translated by: Catherine Jex
Scientific links
- The excess mortality of patients with diabetes and concurrent psychiatric illness is markedly reduced by structured personal diabetes care, General Hospital Psychiatry 2015, DOI: 10.1016/j.genhosppsych.2015.10.001
- Long-term mortality of persons with severe mental illness and diabetes: a population-based cohort study in Denmark, Psychological Medicine 2014, DOI: http://dx.doi.org/10.1017/S0033291714000634
