Barriers to effective diabetes management - a survey of people with severe mental illness

Journal article


Mulligan, K, McBain, HB, Lamontagne-Godwin, F, Chapman, J, Flood, C, Haddad, M, Jones, J and Simpson, A (2018). Barriers to effective diabetes management - a survey of people with severe mental illness. BMC Psychiatry. 18 (1), p. 165.
AuthorsMulligan, K, McBain, HB, Lamontagne-Godwin, F, Chapman, J, Flood, C, Haddad, M, Jones, J and Simpson, A
Abstract

Background: People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of developing type 2 diabetes and have poorer health outcomes than those with diabetes alone. To maintain good diabetes control, people with diabetes are advised to engage in several self-management behaviours. The aim of this study was to identify barriers or enablers of diabetes self-management experienced by people with SMI. Methods: Adults with type 2 diabetes and SMI were recruited through UK National Health Service organisations and mental health and diabetes charities. Participants completed an anonymous survey consisting of: Summary of Diabetes Self-Care Activities (SDSCA); CORE-10 measure of psychological distress; a measure of barriers and enablers of diabetes self-management based on the Theoretical Domains Framework; Diabetes UK care survey on receipt of 14 essential aspects of diabetes healthcare. To identify the strongest explanatory variables of SDSCA outcomes, significant variables (p \ensuremath< .05) identified from univariate analyses were entered into multiple regressions. Results: Most of the seventy-seven participants had bipolar disorder (42%) or schizophrenia (36%). They received a mean of 7.6 (SD 3.0) diabetes healthcare essentials. Only 28.6% had developed a diabetes care plan with their health professional and only 40% reported receiving specialist psychological support. Engagement in self-management activities was variable. Participants reported taking medication on 6.1 (SD 2.0) days in the previous week but other behaviours were less frequent: general diet 4.1 (2.3) days; specific diet 3.6 (1.8) days, taking exercise 2.4 (2.1) days and checking feet on 1.7 (1.8) days. Smoking prevalence was 44%. Participants reported finding regular exercise and following a healthy diet particularly difficult. Factors associated with diabetes self22 management included: the level of diabetes healthcare and support received; emotional wellbeing; priority given to diabetes; perceived ability to manage diabetes or establish a routine to do so; and perceived consequences of diabetes self-management. Conclusions: Several aspects of diabetes healthcare and self-management are suboptimal in people with SMI. There is a need to improve diabetes self-management support for this population by integrating diabetes action plans into care planning and providing adequate psychological support to help people with SMI manage their diabetes.

KeywordsHumans; Diabetes Mellitus, Type 2; Severity of Illness Index; Mental Disorders; Research Design; Adult; Middle Aged; Delivery of Health Care; Disease Management; Female; Male; Self-Management
Year2018
JournalBMC Psychiatry
Journal citation18 (1), p. 165
PublisherBioMed Central
ISSN1471-244X
Digital Object Identifier (DOI)doi:10.1186/s12888-018-1744-5
Web address (URL)http://openaccess.city.ac.uk/19756/
Publication dates
Print01 Jun 2018
Publication process dates
Deposited22 May 2019
Accepted14 May 2018
Publisher's version
License
CC BY 4.0
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https://openresearch.lsbu.ac.uk/item/86qv0

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