Are diabetes self-management programmes for the general diabetes population effective for people with severe mental illness?: a systematic review

Abstract

Background Diabetes self-management education programmes are effective in improving health outcomes in the general population with diabetes. However, it is not known if these programmes include people who also have a severe mental illness (SMI) and, if so, what their outcomes are. The aim of this review was to examine if evaluations of diabetes self-management education programmes included people with SMI, and if so, whether the interventions were beneficial for this population. Methods The inclusion criteria for this systematic review, defined by PICOS criteria, were: Population - Adults with type 2 diabetes; Intervention - self-management education programme; Comparator – another active intervention or usual care; Outcomes of interest – inclusion of people with SMI and the clinical, behavioural and psychosocial outcomes in this population; Study design - randomised controlled trials. The following bibliographic databases were searched from January 2004 to April 2018: Cochrane Library, Medline, Embase, PsychINFO, Allied and Complimentary Medicine Database, Health Technology Assessment, NHS Economic Evaluations Database and CINAHL. Data were extracted on study characteristics, inclusion and exclusion criteria, participant and intervention characteristics, number of participants with SMI, and outcomes for people with SMI, if reported. Authors were contacted by email for missing data. Results A total of 410 trials were included. At least 42% of trials did not recruit any participants with SMI. Only nine confirmed inclusion of participants with SMI, of which six provided data on the number recruited. These six trials recruited a total of 1009 participants, of whom 31 (3.1%) had SMI. It was not possible to assess intervention effectiveness for people with SMI as none of the trials reported outcomes for these participants. Conclusions This systematic review confirms that people with SMI are often excluded from trials of diabetes self-management education, resulting in a lack of an evidence base on which to base treatment paths for this vulnerable population. It cannot be assumed that programmes developed for the general diabetes population meet the needs of people with SMI. Future research needs to examine if and how these programmes could be adapted for people with SMI or if new programmes are required.

Risk of Developing Type 2 Diabetes in Individuals With a Psychiatric Disorder: A Nationwide Register-Based Cohort Study

“…Previous intervention studies have shown that pharmacological and behavioral interventions have a positive impact on individuals with severe psychiatric disorders (43). However, little is known regarding prevention of type 2 diabetes in individuals with a psychiatric disorder (44), which is partially due to the fact that individuals with psychiatric disorders are often excluded from traditional intervention studies, and our knowledge regarding the effect of intervention and preventions studies in this population is limited (45). Our findings also highlight the importance of focusing on prevention of type 2 diabetes in the population of individuals with a psychiatric disorder.…”

Non-Pharmacological Integrated Interventions for Adults Targeting Type 2 Diabetes and Mental Health Comorbidity: A Mixed-Methods Systematic Review

“…Research on the efficacy of non-pharmacological interventions to improve clinical outcomes such as average blood glucose levels (HbA1c), diabetes self-management, and quality of life in the general T2D adult population reports inconsistent findings [ 22 23 ]. Existing interventions have largely been tested with people without SMI; people with SMI are not always specified in studies, or are excluded in reviews [ 24 25 ], making it impossible to generalise these findings to adults with comorbid T2D and SMI [ 20 ].…”

Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis

“…As a consequence of these many barriers, people with SMI might find it difficult to effectively engage with physical health self-management programmes designed for people without SMI. People with SMI also tend to be excluded from trials assessing effectiveness of these programmes [ 17 ]. This points to the need for more tailored interventions that target the challenges people with SMI experience in relation to their self-management [ 18 ].…”