Glucose, cholesterol and blood pressure in type II diabetes: A longitudinal observational study comparing patients with and without severe mental illness

Smith, Robert; Han, Lu; Ali, Shehzad; Prady, Stephanie L.; Taylor, Joanne E.; Hughes, Tom; Ajjan, Ramzi; Siddiqi, Najma; Doran, Tim

doi:10.1111/jpm.12546

Cited by 14 publications

(18 citation statements)

References 28 publications

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“…16 17 21 There is a gap in the literature regarding potential inequalities impacting on glycemic management in people living T2DM and SMI, and most previous work has been cross-sectional 20 or has been impacted through smaller sample sizes, limiting inferences. 22 Therefore, using data from a large primary care cohort serving an ethnically diverse and geographically well-defined region in London, UK, with 10 years' follow-up data, including repeated HbA1c assessments, we sought to assess disparities in glycemic management in people living with T2DM and SMI, taking into account specific inequalities relating to ethnicity, gender, area deprivation, and primary care exception reporting practices. We hypothesized that the presence of disparities across a range of indicators (presence of SMI, ethnicity, gender, deprivation, and mental health exception reporting) would be associated with poorer glycemic management, compared with reference groups.…”

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confidence: 99%

Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses: cohort study from the UK over 10 years

Das‐Munshi

Schofield

Ashworth

et al. 2021

BMJ Open Diab Res Care

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IntroductionUsing data from a a primary care pay-for-performance scheme targeting quality indicators, the objective of this study was to assess if people living with type 2 diabetes mellitus (T2DM) and severe mental illnesses (SMI) experienced poorer glycemic management compared with people living with T2DM alone, and if observed differences varied by race/ethnicity, deprivation, gender, or exclusion from the scheme.Research design and methodsPrimary care data from a cohort of 56 770 people with T2DM, including 2272 people with T2DM and SMI, from London (UK), diagnosed between January 17, 2008 and January 16, 2018, were used. Adjusted mean glycated hemoglobin (HbA1c) and HbA1c differences were assessed using multilevel regression models.ResultsCompared with people with T2DM only, people with T2DM/SMI were more likely to be of an ethnic minority background, excluded from the pay-for-performance scheme and residing in more deprived areas. Across the sample, mean HbA1c was lower in those with T2DM and SMI (mean HbA1c: 58 mmol/mol; 95% CI 57 to 59), compared with people with T2DM only (mean HbA1c: 59 mmol/mol; 95% CI 59 to 60). However, HbA1c levels were greater in Bangladeshi, Indian, Pakistani, and Chinese people compared with the White British reference in the T2DM/SMI group. People with T2DM/SMI who had been excluded from the pay-for-performance scheme, had HbA1c levels which were +7 mmol/mol (95% CI 2 to 11) greater than those with T2DM/SMI not excluded. Irrespective of SMI status, increasing deprivation and male gender were associated with increased HbA1c levels.ConclusionsDespite a pay-for-performance scheme to improve quality standards, inequalities in glycemic management in people with T2DM and SMI persist in those excluded from the scheme and by gender, ethnicity, and area-level deprivation.

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confidence: 99%

Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses: cohort study from the UK over 10 years

Das‐Munshi

Schofield

Ashworth

et al. 2021

BMJ Open Diab Res Care

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“…l Results of our pilot interrogation of CPRD data carried out by the DIAMONDS research group to characterise the population and to develop and test clinical (Read code) lists in preparation for the study 115. l Interventions identified from systematic reviews as being potentially effective in the UK for reducing inequalities in diabetes or SMI care and outcomes [116][117][118]…”

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confidence: 99%

Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study

Lister

Han

Bellass

et al. 2021

Health Serv Deliv Res

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Background People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.

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“…[12,20,[22][23][24][25] For people with SMI and diabetes, self-management support is rarely offered, although reliable data on this are difficult to obtain. [26] Moreover, the effectiveness of diabetes self-management programmes for people with SMI is largely unknown as research typically excludes them. [27][28][29] SMI is characterised by disturbances of thought, perception, affect, and motivation, [30,31] which may adversely influence self-efficacy, literacy, lifestyle, behaviour, and family life.…”

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confidence: 99%

The DIAMONDS intervention to support self-management of type 2 diabetes in people with severe mental illness: study protocol for a single-group feasibility study

Brown

Ajjan

Alderson

et al. 2021

Preprint

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Introduction The DIAMONDS programme aims to evaluate a novel supported diabetes self-management intervention for people with severe mental illness (the DIAMONDS intervention). The purpose of this study is to test the feasibility of intervention delivery and data collection procedures to inform a definitive randomised controlled trial (RCT). Methods Adults aged 18 years or over with a diagnosis of type 2 diabetes and severe mental illness (schizophrenia, schizoaffective disorder, or bipolar disorder) will be eligible for inclusion. Individuals with other types of diabetes or non-psychotic mental illness and those lacking capacity to consent will not be eligible. Participants will be recruited from NHS mental health trusts and general practices across the North of England. All participants will receive the DIAMONDS intervention: weekly one-to-one sessions with a trained facilitator (DIAMONDS Coach) to support goal setting, action planning, and diabetes education; ongoing self-management supported by a paper-based workbook and optional digital application (app); and monthly peer-support group sessions with other participants. The primary outcomes are: 1. Recruitment rate, measured as proportion of the recruitment target (N=30) achieved at 5 months from start of recruitment, 2. Attrition measured as the proportion of missing outcomes data at the end of the recruitment period (5 months from start of recruitment) for physiological and self-reported data items, 3. Intervention delivery rate recorded as the proportion of planned sessions delivered (measured by the number of completed intervention session logs per participant within 15 weeks of the first intervention session). Secondary outcomes include completeness of data collection at baseline and of process evaluation data at follow-up as well as the feasibility and acceptability of the intervention and of wearing a blinded continuous glucose monitoring device. An intervention fidelity framework will also be developed. Recruitment started in July 2021. The study was prospectively registered: ISRCTN15328700 (12th March 2021). Discussion The results of this feasibility study will inform the refinement of the content and delivery of the DIAMONDS intervention, as well as research procedures, including recruitment and data collection, in preparation for the main DIAMONDS RCT.

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Glucose, cholesterol and blood pressure in type II diabetes: A longitudinal observational study comparing patients with and without severe mental illness

Cited by 14 publications

References 28 publications

Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses: cohort study from the UK over 10 years

Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses: cohort study from the UK over 10 years

Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study

The DIAMONDS intervention to support self-management of type 2 diabetes in people with severe mental illness: study protocol for a single-group feasibility study

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