Pharmacologic and Behavioral Interventions to Improve Cardiovascular Risk Factors in Adults With Serious Mental Illness

Gierisch, Jennifer M.; Nieuwsma, Jason A.; Bradford, Daniel W.; Wilder, Christine M.; Mann-Wrobel, Monica C.; McBroom, Amanda J; Hasselblad, Vic; Williams, John W

doi:10.4088/jcp.13r08558

Cited by 52 publications

(58 citation statements)

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“…Data on efficacy of lifestyle modification in youth who receive antipsychotics is limited, as most of the literature, to date, have focused on the adult population. In a systematic review, behavioral interventions in adults with SMI, most of whom received antipsychotic agents, resulted in 3.13 kg more weight loss compared with control interventions [47]. While the CAMESA guidelines include insulin, the measurement of insulin level is not recommended by the ADA or the other endocrine groups for clinical monitoring of risk for diabetes.…”

Section: Lifestyle Modificationmentioning

confidence: 99%

Type 2 Diabetes in Children and Adolescents on Atypical Antipsychotics

Pramyothin

Khaodhiar

2015

Curr Diab Rep

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Youth receiving treatment with antipsychotics are particularly susceptible to weight gain, type 2 diabetes (T2D), and associated metabolic disorders, which is directly associated with excess morbidity and mortality in this vulnerable population. The risk of T2D is 2- to 3-fold that of the general population, starts early in the course of treatment, and reflects the effects of weight gain in conjunction with direct effects of antipsychotics on the hypothalamus, pancreatic beta cells, and insulin-sensitive peripheral tissues. Close monitoring with early intervention through lifestyle intervention, switching away from antipsychotics with deleterious metabolic effects, and adjunctive treatment with metformin are modalities available to mitigate weight gain and improve cardiometabolic health in these patients. Despite rapidly advancing knowledge in the field, patient's access to metabolic screening and quality care remains limited. Efforts must be made to broaden reach of early cardiometabolic intervention among these patients in order to avert serious cardiovascular disease burden in the future.

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Section: Lifestyle Modificationmentioning

confidence: 99%

Type 2 Diabetes in Children and Adolescents on Atypical Antipsychotics

Pramyothin

Khaodhiar

2015

Curr Diab Rep

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“…Studies conducted in community mental health settings show that supported exercise programming can significantly reduce health risks in people with serious mental illness [11][12][13][14] by helping people achieve a healthy weight and better manage chronic disease risk factors [10,[15][16][17]. Regular exercise also increases cardiovascular fitness and helps prevent costly, disease-related disability [11,12,14].…”

Section: Exercise In Community Mental Health Programs To Improve Healthmentioning

confidence: 99%

“…Regular exercise also increases cardiovascular fitness and helps prevent costly, disease-related disability [11,12,14]. Furthermore, exercise reduces psychiatric symptoms, supports brain health, and provides a healthy lifestyle alternative for people with cooccurring nicotine and substance use disorders [13,18].…”

Section: Exercise In Community Mental Health Programs To Improve Healthmentioning

confidence: 99%

“…CURRENT BARRIERS TO OFFERING EXERCISE SERVICES Despite the availability of evidence-based programs to improve physical health and wellness behaviors among people with serious mental illness [11,12], there are multiple policies and funding barriers that make it difficult for community mental health programs to offer these programs to consumers [21,23]. Health care policies typically Bcarve out^mental health funds from physical health funds, denying community mental health programs the financial ability to offer exercise programming [21,23].…”

Section: Exercise Can Reduce the Public Health Burden Of Serious Mentmentioning

confidence: 99%

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Increasing US health plan coverage for exercise programming in community mental health settings for people with serious mental illness: a position statement from the Society of Behavior Medicine and the American College of Sports Medicine

Pratt

Jerome

Schneider

et al. 2016

Behav. Med. Pract. Policy Res.

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“…Although there are more than 40 published systematic reviews of studies targeting physical health in people with SMI, these have focused mainly on anthropological outcomes [5–8], with few investigating diabetes prevention and treatment [9, 10]. It is well-established that modest improvements in glycated haemoglobin (HbA 1c ) and blood glucose levels can avoid onset of diabetes and have a significant impact on preventing diabetic complications in the general population [11].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

et al. 2017

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People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration’s tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.

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Pharmacologic and Behavioral Interventions to Improve Cardiovascular Risk Factors in Adults With Serious Mental Illness

Cited by 52 publications

References 0 publications

Type 2 Diabetes in Children and Adolescents on Atypical Antipsychotics

Type 2 Diabetes in Children and Adolescents on Atypical Antipsychotics

Increasing US health plan coverage for exercise programming in community mental health settings for people with serious mental illness: a position statement from the Society of Behavior Medicine and the American College of Sports Medicine

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

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