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

Abstract

Objective: Adults living with Type 2 diabetes (T2D) and severe mental illness (SMI) disproportionally experience premature mortality and health inequality. Despite this, there is a limited evidence-base and evaluation of non-pharmacological integrated interventions that may contribute to improved patient experience and outcomes. To improve our understanding of how to optimise integrated care for this group, this review evaluates the effectiveness, acceptability, and feasibility of non-pharmacological integrated interventions for adults with SMI and T2D.Methods: Studies from nine electronic databases were searched. Of the 6750 papers retrieved, seven papers (five quantitative and two qualitative) met the inclusion/exclusion criteria. A convergent integrated approach was used to narratively synthesise data into four main themes: effectiveness, acceptability, feasibility, integrated care. Results:There is moderate evidence to suggest non-pharmacological integrated interventions may be effective in improving some diabetes-related and psychosocial outcomes. Person-centred integrated interventions that are delivered collaboratively by trained facilitators who exemplify principles of integrated care may be effective in reducing the health-treatment gap. Conclusions:Recommendations from this review can provide guidance to healthcare professionals, commissioners, and researchers to inform improvements to nonpharmacological integrated interventions that are evidence-based, theoretically driven, and informed by patient and healthcare professionals' experiences of care.

Non-Pharmacological Interventions for Type 2 Diabetes in People Living with Severe Mental Illness: Results of a Systematic Review and Meta-Analysis

“…Non-pharmacological interventions (NPIs) for people with type 2 diabetes and SMI often include exercise, dietary, other lifestyle, educational, and behavioural change interventions [7]. Other NPIs for this population may include motivational interviewing, psychoeducation, and talk therapies, which may involve the use of behavioural change techniques [8]. According to Grøn et al [9], intervention formats in people with diabetes and SMI may include psychosocial treatment (such as psychoeducation, goal setting, behavioural modelling, care linkage, and problem identification), physical activity instruction, diabetes education, and self-management and nutrition counselling.…”

“…There is evidence that unhealthy dietary intake and lifestyle habits form part of the poorer diabetes self-care practices in people with mental illnesses and type 2 diabetes leading to poor blood glucose control [10]. SMI-related barriers, including challenges with compliance, cognitive impairment, and poor communication skills, may impact diabetes self-management [8]. Therefore, lifestyle interventions including improved dietary choices and engagement in physical activity for people with type 2 diabetes and SMI have been found to promote diabetes-education levels, as well as weight management and blood glucose parameters [10].…”

“…Previous systematic reviews that have sought to examine the effectiveness of NPI in people with SMI and type 2 diabetes have been limited either in scope and/or the number of studies included or have been based only on qualitative synthesis of the included studies [7][8][9]. For example, the review by Cimo et al [7] included only four studies, while Tuudah et al [8] and Grøn et al [9] included only seven studies each. In contrast, the current review is a systematic review and meta-analysis with broader scope and includes 14 articles.…”

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

“…Their effect on physical health, however, varies depending on the specific condition 292,369 . Imple menting collaborative care interventions also requires careful con sideration of leadership and delivery resources, costs for ongoing care, and cultural context 370 .…”

The effect of close and intensive therapeutic monitoring of patients with poorly controlled type 2 diabetes with different glycemic background

“…This approach should involve interventions such as meditation, improving sleep patterns, cultivating social support networks, and providing psychological support. [21][22][23][24] Recognizing the need for these interventions is crucial in effectively managing diabetes.…”