People with mental disorders are considerably more likely to die prematurely than the general population. In a systematic review, Harris & Barraclough 1 found that the mortality rate remained higher in individuals with mental disorders when deaths from unnatural causes (suicide and violent death) were excluded. In people with schizophrenia, the standardised mortality ratio (SMR) for all natural causes was 137% (95% CI 134-141%) compared with 100% for a general population of similar age and gender, accounting for 62% of the excess deaths from all causes. Most excess deaths were from infectious, respiratory and digestive system disorders, but deaths from endocrine, circulatory and genitourinary system disorders also had significantly raised SMRs. The SMR for endocrine system disorders, including diabetes, was 238% (95% CI 114-438%). In people with bipolar disorder, the SMR for all natural causes was 150% (95% CI 137-164%), although only deaths from circulatory and respiratory system disorders had significantly raised SMRs.A subsequent study 2 found an SMR of 260 (95% CI 219-306) for all natural causes in people with schizophrenia, mainly as a result of diseases of the circulatory, digestive, endocrine, nervous and respiratory systems, with an SMR of 801 (95% CI 322-1651) for endocrine system disorders. Studies from two states in the USA 3,4 found the life expectancy of people with severe mental illness to be about 9 years lower than that of the general population.The association between severe mental illness and diabetes is now widely recognised. A consensus meeting in 2003 concluded that the overall risk of type 2 diabetes in people with schizophrenia is between two and four times that of the general population, with a prevalence of approximately 15-18%, and that impaired glucose tolerance may affect up to 30% of people with schizophrenia.5 Similar findings have been reported in people with bipolar disorder. 6A study in the USA examined the impact of diabetes on mortality in 197 individuals with co-occurring psychotic and substance use disorders participating in a randomised controlled study of integrated mental health and substance misuse treatment. The study found that participants with evidence of diabetes were significantly more likely to die during follow-up than participants without evidence of diabetes.7 However, no study has yet demonstrated this in a naturalistic population sample. This study examines mortality rates in a cohort of people with diabetes, comparing those with and without schizophrenia and bipolar disorder. It tests the hypothesis that having one of these mental illnesses increases the risk of premature death in individuals with diabetes in a large and representative primary care population sample. Method ParticipantsThe study used the QRESEARCH database version 8 (www. qresearch.org/), which is derived from the computerised health records of general practices using the Egton Medical Information System (EMIS) medical record computer system (Egton Medical Information Systems Limited, Leeds, ...

The hypothesis of poorer diabetes care for those with severe mental illness is disproved, perhaps surprisingly, in the light of other recent UK studies showing inequalities in care for the mentally ill. The study does not reveal who is providing this good care (general practitioners, psychiatrists or diabetologists) or take account of the estimated 600 000 people in the UK with undiagnosed diabetes.

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