The management of diabetes in adults and children with psychiatric disorders in inpatient settings

Abstract

Nearly every category of ICD-10 Chapter F (mental disorders) is associated with diabetes and with worse outcomes and premature mortality.1 In addition, many people with diabetes suffer from diabetes related distress. The quality of the diabetes care provided for people with mental illness is suboptimal regardless of whether the clinical presentation is in acute or mental health settings or primary care. However, when patients are admitted, there is often an urgent clinical need to optimise both conditions. We have chosen the inpatient setting because it is also a window of opportunity to effect better shared care planning and decision making. This working group gives guidance for reconfiguring of services to reduce the alarmingly high rates of morbidity and premature mortality related to diabetes in people with mental illnesses. We expect equivalent levels of care for diabetes in people with and without mental illness in order to improve mental health and reduce the risk of diabetes complications. We encourage good practice through collaborative working, raising awareness, improved communication, introducing mandatory training and skills competencies all embedded in a patient-centred approach. Local variation in diabetes outcomes in those with and without mental illnesses should be audited, and commissioners held to account if services are not meeting the needs of this high risk and vulnerable group. There is a need for more commissioning and research investment to develop and evaluate novel clinical innovations to better support our patients with both diabetes and mental illness. There is a need for a system and culture change in the NHS to genuinely integrate the mind and body and incentivise best practice.