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  • Review Article
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Diabetes mellitus and severe mental illness: mechanisms and clinical implications

Nature Reviews Endocrinology volume 11, pages 79–89 (2015)Cite this article

Subjects

Key Points

  • Diabetes mellitus affects ∼12% of patients with severe mental illness (SMI)

  • In people with SMI, diabetes mellitus is associated with higher rates of microvascular and macrovascular complications, acute metabolic dysregulation and deaths related to diabetes mellitus than in people without SMI

  • The mechanisms underlying the association between diabetes mellitus and SMI are multifactorial and include genetic and environmental factors as well as effects of the illness and its treatment

  • Screening for diabetes mellitus in individuals with SMI is needed to identify the high proportion of people with undiagnosed diabetes mellitus

  • Tailored lifestyle interventions can decrease body weight in people with SMI and could potentially reduce the incidence of diabetes mellitus

  • Effective management of diabetes mellitus, incorporating primary care, diabetes mellitus services and mental health teams, is essential to reduce the poor health outcomes and current inequity experienced by people with SMI and diabetes mellitus

Abstract

The prevalence of diabetes mellitus is twofold to threefold higher in people with severe mental illness (SMI) than in the general population, with diabetes mellitus affecting ∼12% of people receiving antipsychotics. The consequences of diabetes mellitus are more severe and frequent in people with SMI than in those without these conditions, with increased rates of microvascular and macrovascular complications, acute metabolic dysregulation and deaths related to diabetes mellitus. Multiple complex mechanisms underlie the association between diabetes mellitus and SMI; these mechanisms include genetic, environmental and disease-specific factors, and treatment-specific factors. Although antipsychotics are the mainstay of treatment in SMI, a causative link, albeit of uncertain magnitude, seems to exist between antipsychotics and diabetes mellitus. The principles of managing diabetes mellitus in people with SMI are similar to those for the general population and should follow currently established treatment algorithms. Lifestyle interventions are needed to reduce incident diabetes mellitus. In addition, improved uptake of opportunities to screen for this disease will reduce the high prevalence of undiagnosed diabetes mellitus. Currently, people with SMI receive poorer treatment for diabetes mellitus than the general population. Thus, health-care professionals in primary care, diabetes mellitus services and mental health teams have a responsibility to ensure that patients with SMI are not disadvantaged.

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Figure 1: The mechanisms that explain the association between severe mental illness and type 2 diabetes mellitus.

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Authors and Affiliations

  1. Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK

    Richard I. G. Holt

  2. Department of Cancer Studies and Molecular Medicine, Infirmary Close, University of Leicester, Leicester, LE1 5WW, UK

    Alex J. Mitchell

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  1. Richard I. G. Holt
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Contributions

R.I.G.H. researched data for the article, contributed to discussion of the content and wrote the article. A.J.M. researched data for the article, contributed to discussion of the content and reviewed/edited the manuscript before submission.

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Correspondence to Richard I. G. Holt.

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Competing interests

R.I.G.H. has acted as an advisory board member and speaker for Novo Nordisk, and as a speaker for Boehringer Ingelheim, Bristol–Myers Squibb, Eli Lilly, Janssen, Lundbeck, Merck Sharpe and Dohme, Otsuka and Sanofi–Aventis. He has received grants in support of investigator trials from Novo Nordisk. A.J.M. declares no competing interests.

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Holt, R., Mitchell, A. Diabetes mellitus and severe mental illness: mechanisms and clinical implications. Nat Rev Endocrinol 11, 79–89 (2015). https://doi.org/10.1038/nrendo.2014.203

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