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Diabetes and mental health guidelines published

By Editor
18th October 2017
Clinical guidance, Commissioning Good practice Inpatient

A mental health and diabetes treatment guideline for inpatient staff has been issued. 

The first edition of the document has been developed by the Joint British Diabetes Societies for Inpatient Care (JBDS–IP) on behalf of RCPsych Faculty of Liaison Psychiatry, and was supported by Diabetes UK, the Association of British Clinical Diabetologists (ABCD) and the Diabetes Inpatient Specialist Nurse (DISN) UK Group.

Entitled The Management of Diabetes in Adults and Children with Psychiatric Disorders in Inpatient Settings, the document was created because the association between diabetes and mental illness is well recognised. However, together both conditions can lead to poor health outcomes and integrated care remains “poor and commissioned services to improve the care for these patients are almost non-existent”.

Drafted by Professor Khalida Ismail, consultant liaison psychiatrist and Dr Hermione Price, consultant diabetologist, they said: “We urge healthcare professionals working in both mental health and diabetes care to use these guidelines to start conversations with their own trusts and commissioners to ensure that local services meet the needs of this group of patients.”

The association between diabetes and mental illness is well recognised, and this co-morbidity leads to worse outcomes for both conditions. Despite this, integrated care for these patients remains poor and commissioned services to improve the care for these patients are almost non-existent

The purpose of the guidelines is ensure the level of care for people who suffer from both severe mental illness and diabetes receives a better standard of care which will help “reduce the alarmingly high rates of morbidity and premature mortality”.

The authors wrote: “We expect equivalent levels of care for diabetes in people with and without mental illness in order to improve health and reduce the risk of diabetes related complications. We encourage good practice through collaborative working and a patient-centred approach.

“Local variation in diabetes outcomes in those with and without mental illnesses should be challenged and commissioners held to account if services are not meeting the needs of this high risk and vulnerable group. A change in culture is needed that adopts the mind-body model of integrated care and incentivises best practice.”

Immediate and long-term recommendations have been laid out in the document. Some of the suggestions include:

  • In mental health and residential settings, screening for diabetes in those not known to have the condition and performing a diabetes review (with particular emphasis on reducing the risk of hypoglycaemia) in those who do is always indicated in any older adult. This should include a medication review to ensure that anti- diabetes drugs with a low risk of hypoglycaemia are used, and where insulin is required, the regimen and dose schedule should be reviewed regularly to adjust to changing circumstances.
  • In acute trust inpatient settings, older adults with diabetes should have a mental health assessment for cognitive impairment, depression, psychosis and alcohol use if there are concerns that impaired cognition is hindering diabetes self-management or may have contributed to the need for hospital admission (for example hyperglycaemia due to missed insulin administration). This should be aligned with current local de nitions for ‘older’ and pathways for memory screening services.
  • Acute trusts and older adult mental health and services should share the same clinical pathways for both diabetes and dementia. The focus should be on early recognition that a person has developed diabetes, applying a common set of key principles of care, safe medication usage, and implementing a 4-step approach for each condition that allows local policies of care to be adapted to enhance the quality of care in both conditions.
  • Implement a competency framework in acute NHS trusts, primary care and care home settings that outlines the training and educational needs of direct care staff in the management of patients with diabetes and dementia.

To read the recommendations in full and the rest of the document, click here.

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