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People with diabetes and comorbid mental disorders are less likely to receive guideline-based medical care than people with diabetes without mental disorders. A new systematic review and meta-analysis of data from over 5.5 million people shows significant differences in care – with potentially serious consequences for life expectancy. The meta-analysis, conducted at the Medical Faculty of the University of Augsburg, has been published in the highly renowned journal The Lancet Psychiatry.
People with mental illness have a higher risk of developing diabetes due to multiple factors. However, they do not receive adequate medical care for existing diabetes, as an international study led by the Medical Faculty of the University of Augsburg now shows.
In a comprehensive systematic review and meta-analysis, the scientists evaluated data from 49 studies involving a total of more than 5.5 million people with diabetes and summarized their findings quantitatively. Around 15 percent (840,000) of the patients examined also had a diagnosed mental illness.
The lead author and head of the study, which was published in the journal The Lancet, is Prof. Dr. med. Elias Wagner, head of the Evidence-Based Psychiatry and Psychotherapy section at the Chair and Clinic for Psychiatry, Psychotherapy, and Psychosomatics at the University of Augsburg. It is the first scientific paper to quantitatively compare diabetes quality-of-care indicators between individuals with and without comorbid mental disorders.
Significantly lower probability for recommended monitoring
The key finding: people with mental illness are less likely to receive the recommended diabetes check-ups. Overall, they were almost 20 percent less likely to receive guideline-based monitoring and care than people without mental illnesses.
People with diabetes and mental illness were underserved in terms of basic diabetes management measures and the prevention of typical complications: measuring HbA1c levels, commonly referred to as long-term blood sugar levels; eye examinations for the early detection of diabetic retinal damage; checks of lipid metabolism and kidney function; and foot examinations to detect nerve damage at an early stage.
These gaps in care occurred across various mental illnesses, including depression, schizophrenia, bipolar disorder, and addiction.
Inequality also in drug treatment
There were also relevant differences in drug therapy. People with mental illness were more likely to receive insulin treatment, but were less likely to receive modern GLP-1 receptor agonists, which can lower blood sugar and reduce cardiovascular risk in type 2 diabetes.
This finding is particularly critical from the researchers' point of view, as people with mental illness already have an increased risk of cardiovascular disease and a shorter life expectancy.
Remove structural barriers
"Our findings reveal persistent gaps in diabetes care for people with mental disorders, which require targeted measures to eliminate these inequalities," says study leader Elias Wagner. "Beyond targeted interventions, the results also underscore the need to address fundamental structural and organizational barriers in order to steer preventive measures regarding diabetes care in high-risk groups."
Further studies are needed to investigate exactly how the quality of care can be improved. "This requires strategies at the system level," adds Prof. Dr. Alkomiet Hasan, Chair of Psychiatry and Psychotherapy. "Structural barriers in the healthcare system should be removed and somatic and mental health care should be more closely integrated." This varies from country to country.
The present study analyzed patient data from the US, Europe, Asia, and Australia, with most of the data coming from the US.
Univ. Prof. Dr. med. Elias Wagner
Sektionsleiter Psychiatrie und Psychotherapie
Telefon: +49 821 - 48030
elias.wagner@med.uni-augsburg.de
Univ. Prof. Dr. med. Alkomiet Hasan
Lehrstuhlinhaber Psychiatrie und Psychotherapie
Telefon: +49 (0) 821 4803-1001
alkomiet.hasan@med.uni-augsburg.de
Disparities in diabetes treatment and monitoring for people with and without mental disorders: a systematic review and meta-analysis, Wagner, Elias et al., The Lancet Psychiatry, Volume 0, Issue 0.
www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00332-3/fulltext
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