Diabetes Screening, Risk Management and Disease Management in a High-Risk Mental Health Population Part II

2014-08-27 03:42:29 | BioPortfolio


The purpose of this study is to learn more about the relationship between serious mental illness and the detection and management of diabetes and pre-diabetic conditions. Patients who have been diagnosed with schizophrenia are at an increased risk for developing diabetes and pre-diabetic conditions such as impaired glucose tolerance and impaired fasting glucose. In addition, novel antipsychotics have also been linked to impaired glucose metabolism and increased incidence of diabetes. The medical management of these patients may be difficult ot achieve through standard family practice. The objectives of this project are to: screen a sample of this high-risk population using an Oral Glucose Tolerance Test (OGTT), and to provide multidisciplinary team support to those identified as having diabetes or a pre-diabetic condition.


Many studies suggest that the extensive psychiatric needs of some patients could take attention away from management of other health problems and from the usual health promotion services physicians provide. Studies suggest that medical comorbidity has often been under recognized and under diagnosed in psychiatric patients, especially among those with schizophrenia. Unrecognized physical diseases are often associated with serious, potentially fatal illness, and may exacerbate the symptoms of psychiatric illness.

The disorder of schizophrenia has been repeatedly associated with a higher than normal incidence of medical illnesses- specifically, diabetes mellitus (DM). The prevalence of DM in a retrospective study of 95 chronic schizophrenic patients was found to be 15.8% - 4 to 5 times higher than that reported in epidemiological surveys in the general population. This increased risk has recently been formally recognized in the Canadian diabetes practice guidelines. In addition, the first line treatment of schizophrenia as per many published clinical practice algorithms, novel antipsychotics (NAP), has been associated independently with increased risk for diabetes. Novel antipsychotics such as clozapine, olanzapine, quetiapine, and risperidone have demonstrated efficacy in the treatment of schizophrenia with generally fewer extrapyramidal side effects than high dosed typical neuroleptics. However, there is accumulating data suggesting that treatment with at least some of the NAPs may be associated with the development of DM and associated risk factors. The use of olanzapine, for example, has been associated with weight gain, exacerbation of previously well-controlled diabetes, and onset of type 1 and type 2 diabetes. Clozapine has also been associated with weight gain in several reports, as well as increased risk of developing diabetes, and at least one report citing deaths from diabetic ketoacidosis after long-term use.

High-risk groups need targeted diabetes strategies. The Canadian diabetes practice guidelines outline that the service model needed to achieve the benchmarks set for diabetes care will need to be designed to reflect the unique diabetes related challenges faced by various segments of the diabetes epidemic. Diabetes care should be organized around a multidisciplinary diabetes healthcare (DHC) team that can establish and sustain a communication network between the person with DM and the necessary healthcare and community systems. The high risk mental health communities in Ontario need a targeted primary health care service delivery model that attends to the unique set of diabetes related challenges they face, including: weight increase related to medication use, inadequate self-care resources and capacity related to poverty, social constraints and lack of supports, communication barriers and mental health symptomology impacting interactions with service providers.

Current guidelines for diabetes management are clear regarding the monitoring and treatment of identified high-risk groups. Screening for DM should be performed every three years in individuals over 40 years of age. However, more frequent and/or earlier testing with a 75-g Oral Glucose Tolerance Test (OGTT) should be considered in people with identified risk factors such as schizophrenia and NAP use. Annual screening could detect individuals with undiagnosed DM as well as individuals with the pre-diabetic conditions of Impaired Fasting Glucose and Impaired Glucose Tolerance. Results of large, well-designed studies assessing early interventions in adults to prevent the progression from pre-diabetic conditions to DM have recently been published. These studies have demonstrated significant risk reduction with lifestyle management and appropriate pharmacologic interventions. It is also well documented that a comprehensive multidisciplinary Diabetes Healthcare team can help slow the progression of the disease and reduce the incidence of DM-related complications for those already diagnosed with DM.

The London Intercommunity Health Centre (LIHC) has recently piloted a diabetes program addressing the needs of a high-risk mental health population within the recommended guidelines. The program was designed as a “one stop shop” for self-management teaching, medication and glucose monitoring, and referral to specialist providers as needed. The structure of the program followed the Canadian Diabetes Association Clinical Practice Guidelines. Although the program has yet to be implemented long enough to determine if the progression from pre-diabetes to diabetes was prevented, pre-diabetic patients involved in the program have demonstrate clinically significant improvement in lipid profiles and blood pressure measurements. Those patients diagnosed with DM, who participated in the program, were found to attend regularly, and demonstrated a clinically significant improvement in their metabolic control. Thus, initial results from the LIHC, and a recent extension of this model into a community population, indicate that this model of diabetes care for this high-risk mental health population is promising for diabetes risk and disease management.

Study Design

Observational Model: Defined Population, Primary Purpose: Screening, Time Perspective: Longitudinal, Time Perspective: Retrospective/Prospective


Diabetes Mellitus


Management, Screening


Regional Mental Health Care London
N6A 4H1




Lawson Health Research Institute

Results (where available)

View Results


Published on BioPortfolio: 2014-08-27T03:42:29-0400

Clinical Trials [4657 Associated Clinical Trials listed on BioPortfolio]

Randomization of Early Diabetes Screening Among Obese Pregnant Women.

This will be a randomization of two groups of obese pregnant women into early screening for diabetes mellitus at the time of their first or subsequent prenatal visits before 20 weeks of ge...

Women in Control: A Virtual World Study of Diabetes Self-Management

This study evaluates the comparative effectiveness of a diabetes self management (DSM) group medical visit in the virtual world (Second life) verses a face-to-face format, aimed to increas...

Fostering Sustainability Through Diabetes Self-Management Support

To understand the effectiveness of three approaches to address diabetes self-management support compared to enhanced usual care in church-based settings.

Southeastern Diabetes Initiative Clinical Intervention

The purpose of the Southeastern Diabetes Initiative Clinical Intervention is to augment existing standard of care in an effort to (1) improve population level diabetes management, health o...

Increasing Screening for Type 2 Diabetes in Women With Previous Gestational Diabetes.

In 1998, The Canadian Diabetes Association published guidelines that recommended women diagnosed with gestational diabetes mellitus (GDM,) should be screened postpartum for Type 2 diabetes...

PubMed Articles [14235 Associated PubMed Articles listed on BioPortfolio]

Capacity and capability of Tanzania health facilities to diagnose and manage diabetes mellitus in pregnancy.

Gestational Diabetes Mellitus (GDM) remains a neglected cause of maternal and foetal morbidity and mortality in developing countries exacerbated by limited screening and management strategies. This st...

Impact of diabetes education and self-management on the quality of care for people with type 1 diabetes mellitus in the Middle East (The International Diabetes Mellitus Practices Study, IDMPS).

Self-management (self-monitoring of blood glucose, plus self-adjustment of insulin dose) is important in diabetes care, but its complexity presents a barrier to wider implementation, which hinders att...

Structuring Diabetes Mellitus Care in Long-Term Nursing Home Residents.

Nursing home residents with diabetes have more complex care needs with higher levels of comorbidity, disability and cognitive impairment. We compared current practice in the 44 long-term residents in ...

Use of point-of-care HbA measurement to estimate the level of undiagnosed diabetes mellitus among 67-year-old participants in a cardiovascular screening programme in the municipality of Viborg, Denmark.

To determine the prevalence of unidentified diabetes mellitus among 67-year-olds in Denmark participating in a screening programme focusing on cardiovascular disease and diabetes, and to describe glyc...

Gender-specific Knowledge of Diabetes and Its Management Among Patients Visiting Outpatient Clinics in Faisalabad, Pakistan.

Diabetes mellitus is an emerging public health concern. The aim of this study was to assess the gender-specific knowledge of patients about diabetes mellitus, its complications, and its management.

Medical and Biotech [MESH] Definitions

A subclass of DIABETES MELLITUS that is not INSULIN-responsive or dependent (NIDDM). It is characterized initially by INSULIN RESISTANCE and HYPERINSULINEMIA; and eventually by GLUCOSE INTOLERANCE; HYPERGLYCEMIA; and overt diabetes. Type II diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop KETOSIS but often exhibit OBESITY.

Diabetes mellitus induced experimentally by administration of various diabetogenic agents or by PANCREATECTOMY.

Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes (DIABETES MELLITUS; DIABETES INSIPIDUS).

A subtype of DIABETES MELLITUS that is characterized by INSULIN deficiency. It is manifested by the sudden onset of severe HYPERGLYCEMIA, rapid progression to DIABETIC KETOACIDOSIS, and DEATH unless treated with insulin. The disease may occur at any age, but is most common in childhood or adolescence.

A strain of Rattus norvegicus which is a model for spontaneous insulin-dependent diabetes mellitus (DIABETES MELLITUS, INSULIN-DEPENDENT).

More From BioPortfolio on "Diabetes Screening, Risk Management and Disease Management in a High-Risk Mental Health Population Part II"

Quick Search


Relevant Topics

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. The two main types of diabetes are: type 1 diabetes type 2 diabetes In the UK, diabetes affects approximately 2.9 million people. There are a...

Schizophrenia is a common  serious long-term mental health condition that affects 5 in 1000 in the UK. It causes a range of different psychological symptoms; hallucinations, delusions, muddled thoughts based on the hallucinations or delusions and ch...

Searches Linking to this Trial