Quality of diabetes care in people with diabetes and psychiatric disorders

People with psychiatric disorders, such as schizophrenia or major depression, have a 2-3 times higher risk of developing type 2 diabetes than the general population. The co-existence of diabetes and psychiatric disorder is associated with a higher risk of complications and mortality. The reason for the disparity is complex and not yet fully understood. It may partly be due to side effects of antipsychotic medication and unhealthy lifestyle, but it could also be due to suboptimal treatment. Psychiatric health professionals have been suggested to play a vital role in improving diabetes outcomes in this population. However, lack of diabetes knowledge and skills is a barrier to improving these outcomes.
Therefore, this thesis’s overall objective was to examine quality of diabetes care in people with diabetes and psychiatric disorders (Study 1 and 2) and to examine the effect of diabetes training of psychiatric health professionals. The effect was measured on the psychiatric health professionals’ diabetes knowledge and skills and quality of diabetes care, diabetes support and psycho-social health in people with diabetes and psychiatric disorders (Study 3).
This was done by examining differences in quality of diabetes care in people with type 2 diabetes and a psychiatric disorder compared to people with diabetes without a psychiatric disorder in a nationwide register-based Study (Study 1). Accordingly, I examined quality of diabetes care, diabetes management, experience of diabetes support and psycho-social health (e.g. diabetes distress) in people in current treatment at psychiatric out-patient clinics in the Capital Region of Denmark (Study 2). This was followed up with an intervention, where all psychiatric health professionals from four psychiatric outpatient clinics (the intervention clinics) received three days of training in diabetes, while the last four clinics continued usual care (the control clinics). The effect of the diabetes training was measured on the psychiatric health professionals’ diabetes knowledge and skills, and quality of diabetes care, diabetes support and psycho-social health after 6- and 12- months follow-up in people, with diabetes, treated in the intervention clinics compared to people treated in the control clinics (Study 3).
The findings of the thesis were that people with psychiatric disorders had a markedly reduced quality of diabetes care compared to people without psychiatric disorders, with the most pronounced difference in receiving an assessment of urine albumin creatinine ratio and eye screening (Study 1). A high proportion of people treated in the participating psychiatric outpatient clinics received diabetes care according to the National Guidelines, although a low proportion achieved well-regulated levels of low-density lipoprotein cholesterol. At the same time, the majority experienced low well-being, and 51% experienced high diabetes distress (Study 2).
Psychiatric health professionals gained more diabetes knowledge and skills after the diabetes training. People treated in the intervention clinics had improvements in all clinical measures after 6- and 12- months follow-up and less diabetes distress at 12-month follow-up compared to people treated in the control clinics (Study 3).
Co-existing diabetes and psychiatric disorders are associated with a markedly lower quality of diabetes care. People with diabetes and psychiatric disorders treated at psychiatric outpatient clinics experienced high diabetes distress and low well-being. A solution may be more integrated care obtained by increasing skills and knowledge in psychiatric health professionals. Diabetes training improved diabetes knowledge and skills in psychiatric health professionals and improved clinical measures and diabetes distress in people with diabetes and psychiatric disorders.