Abstract
BackgroundPeople with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of developing type 2 diabetes and have poorer health outcomes than those with diabetes alone. To maintain good diabetes control, people with diabetes are advised to engage in several self-management behaviours. The aim of this study was to identify barriers or enablers of diabetes self-management experienced by people with SMI.MethodsAdults with type 2 diabetes and SMI were recruited through UK National Health Service organisations and mental health and diabetes charities. Participants completed an anonymous survey consisting of: Summary of Diabetes Self-Care Activities (SDSCA); CORE-10 measure of psychological distress; a measure of barriers and enablers of diabetes self-management based on the Theoretical Domains Framework; Diabetes UK care survey on receipt of 14 essential aspects of diabetes healthcare. To identify the strongest explanatory variables of SDSCA outcomes, significant variables (p < .05) identified from univariate analyses were entered into multiple regressions.ResultsMost of the 77 participants had bipolar disorder (42%) or schizophrenia (36%). They received a mean of 7.6 (SD 3.0) diabetes healthcare essentials. Only 28.6% had developed a diabetes care plan with their health professional and only 40% reported receiving specialist psychological support. Engagement in self-management activities was variable. Participants reported taking medication on 6.1 (SD 2.0) days in the previous week but other behaviours were less frequent: general diet 4.1 (2.3) days; specific diet 3.6 (1.8) days, taking exercise 2.4 (2.1) days and checking feet on 1.7 (1.8) days. Smoking prevalence was 44%. Participants reported finding regular exercise and following a healthy diet particularly difficult. Factors associated with diabetes self-management included: the level of diabetes healthcare and support received; emotional wellbeing; priority given to diabetes; perceived ability to manage diabetes or establish a routine to do so; and perceived consequences of diabetes self-management.ConclusionsSeveral aspects of diabetes healthcare and self-management are suboptimal in people with SMI. There is a need to improve diabetes self-management support for this population by integrating diabetes action plans into care planning and providing adequate psychological support to help people with SMI manage their diabetes.
Highlights
People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of developing type 2 diabetes and have poorer health outcomes than those with diabetes alone
In a recent qualitative interview study that informed the current research [11], we found that suboptimal diabetes self-management in people with SMI did not appear to be explained by a lack of knowledge of the recommended self-management behaviours or of the potential consequences of poor diabetes control; people with SMI reported awareness of both but found it difficult to adopt and/or maintain the recommended behaviours
Several factors emerged as important for diabetes self-management, including the degree to which participants were receiving recommended diabetes healthcare, the support they received, their emotional wellbeing, the priority they give to diabetes, their perceived ability to manage diabetes or establish a routine to do so and the perceived consequences of not managing their diabetes
Summary
People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of developing type 2 diabetes and have poorer health outcomes than those with diabetes alone. People with severe mental illnesses (SMI), such as schizophrenia and bipolar disorder, have poorer physical health than the general population [1, 2]. To maintain good diabetes control and reduce the risk of complications, people with diabetes are advised to engage in several self-management behaviours. These may include taking medication, eating a healthy diet, taking regular physical activity, giving up smoking, monitoring blood glucose levels, examining their feet and attending regular health checks, including retinopathy screening. A study in Taiwan that used the same measure of self-management behaviour as DAWN2 found that performance was poorer in people with diabetes and schizophrenia than in those with diabetes alone [10]
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