Diabetes and Mental Health

Diabetes is a growing problem in the UK, with 4.3 million people currently diagnosed¹, with this number expected to rise even further in the coming years. It is important to diagnose diabetes as early as possible to limit the adverse effect it can have on the body. Uncontrolled diabetes leads to higher morbidity and mortality rates.

If blood glucose is not managed properly and high glucose levels are allowed to persist, this can cause damage to the walls of the blood vessels. This can increase the chances of developing diabetes complications such as nephropathy, neuropathy and cardiovascular diseases.

Diabetes and mental health

Diabetes is two to three times more prevalent in people with severe mental illness, than in the general population². This is due to the fact that mental health sufferers have generally lower access to health services, self-neglect, use of psychotropic medication and possible genetic factors. Also mental health sufferers can be more likely to be unemployed⁴ or have low incomes⁵⁶ which may be contributory factors.

Therefore, it is extremely important to test patients with a mental illness for diabetes on admission and periodically during their stay.

There are many drugs that can cause patients to put on weight and increase the likelihood of developing diabetes. The most common in this respect are the newer anticonvulsants: clozapine, olanzapine and quetiapine. Since most patients will be exposed to polypharmacy with these agents, careful monitoring and review are recommended.

Seeing as mental health patients are already at a higher risk of diabetes, screening those newly diagnosed with a mental illness is a good opportunity to catch any pre-existing conditions. For those started on one of the new antipsychotics, a six-monthly check up is recommended. All patients should also have an annual check of their fasting blood glucose done as part of their wider physical health.

Are all of the patients in your hospital screened for diabetes?

• Type 2 diabetes can remain undetected for ten years or more, so it is important to screen all patients
• Diabetic patients require ongoing monitoring and treatment to maintain health
• Incorrect administration of insulin and antidiabetic medication can have harmful and serious consequences

Diabetes care in England

A new report in May 2023 from Diabetes UK explores the state of diabetes care in England, and found that there are stark health inequalities, with people from poorer areas struggling most to access vital services in relation to their care. It also found that:

‘less than half (47%) of people living with diabetes in England received all eight of their required checks in 2021-22, meaning 1.9 million people did not receive the care they need.’³

There were more than 7,000 excess deaths involving diabetes in 2022³, and each week it leads to more than 184 amputations, 770 strokes, 590 heart attacks and 2,300 cases of heart failure³. These shocking figures show just how important it is that diabetes is managed properly, as with the right care and support, many diabetes-related complications can often be prevented.

The full report can be read on the Diabetes UK website.

Managing diabetes

Treatment for diabetes involves either directly injecting insulin to increase its level, stimulating the pancreas to create more insulin or trying to reduce any resistance to insulin that has developed. The exact treatment used depends on the type of diabetes the patient has, as well as how well they have responded to treatments and whether any side effects have developed.

For Healthcare Professionals

For Healthcare professionals (HCPs) there are many resources to provide training and best practice guidance for looking after patients with diabetes. Charities like Diabetes UK have some great resources and tools for HCPs and healthcare bodies like NICE have a variety of clinical guidelines, which are consistently reviewed against the latest evidence. In May 2023 NICE updated their NG18 guidance on ‘Diabetes (type 1 and type 2) in children and young people: diagnosis and management’, where they made new recommendations on blood glucose monitoring and management for children and young people with type 2 diabetes. We have also produced the below two useful resources, and Ashtons Visiting Pharmacists can provide support and guidance in managing diabetes.

• Ashtons training seminar on diabetes

Ashtons can offer a training seminar on ‘Diabetes Mellitus and Mental Health’. We can also offer training on ‘Management of Diabetes Towards the End of Life’ for palliative care sites. To book these seminars for your sites, just speak to your visiting pharmacist.

• Ashtons Guide to Diabetes

Our comprehensive clinical guide on diabetes covers the different types of diabetes, causes, treatment types, and also the correlation between diabetes and mental health. This is accessible through Ashtons Live View.

In April 2023 NHS England published their commissioning recommendations following a national assessment of blood glucose and ketone meters, testing strips and lancets. This clinically led assessment was undertaken to better understand the products available and how they meet the needs of all people living with diabetes. The useful guidance separates types of meters/devices into categories based on patient cohort and could be a useful resource for healthcare professionals in supporting patients to manage diabetes.

For Patients

For patients newly diagnosed, learning how to manage their diabetes can be overwhelming. Often this is due to being confronted with suddenly needing to monitor their blood glucose levels daily, using unfamiliar equipment. Luckily there are many great resources out there to help patients. MyType1 Diabetes has created a fantastic new free resource to help patients manage their diabetes. It includes seven accredited diabetes eLearning courses including carbohydrate counting, living with type 1 diabetes and diabetes technology.

You can access the site here: https://www.mytype1diabetes.nhs.uk/