People with diabetes and mental comorbidities are less likely to receive guideline-compliant medical check-ups than those without mental illnesses. A new systematic review and meta-analysis with data from over 5.5 million people reveals significant differences in care that potentially affect life expectancy. The study, conducted at the Medical Faculty of the University of Augsburg, was published in the journal The Lancet Psychiatry.

According to the paper, people with mental illnesses have a multifactorial higher risk of developing diabetes. However, in the case of existing diabetes, there is a lack of sufficient medical care, as the international study led by the Augsburg faculty shows. The researchers analyzed 49 studies with more than 5.5 million diabetes patients. Of these, about 15 percent, around 840,000 people, had a diagnosed mental illness.

For the first time, the thesis quantitatively compares diabetes quality-of-care indicators between groups with and without mental comorbidities. The key finding: People with mental illnesses are almost 20 percent less likely to receive guideline-compliant monitoring and care.

Undersupply is evident in basic measures of diabetes management and the prevention of consequential damage. Affected are measurements of the HbA1c value, eye examinations for the early detection of diabetic retinopathy, checks of lipid metabolism and kidney function, and foot examinations to detect neuropathic damage. These deficits occur across various mental health conditions, including depression, schizophrenia, bipolar disorder, and addictions.

According to the study, there are also differences in drug therapy: People with mental illnesses are prescribed insulin more often, but have lower chances of receiving modern GLP-1 receptor agonists. These drugs lower blood sugar in type 2 diabetes and reduce the risk of cardiovascular disease. This finding is particularly worrying because people with mental illness already have an increased cardiovascular risk and a shortened life expectancy.

The study analyzed data from the U.S., Europe, Asia, and Australia, with a focus on the U.S. The results highlight persistent gaps in diabetes care. Targeted action is needed to address these inequalities. Beyond interventions, fundamental structural and organisational barriers must be addressed in order to improve prevention measures in high-risk groups.

How exactly the quality of care can be increased requires further investigations. Strategies at the system level are necessary to break down barriers in the health care system and to link somatic and mental health care more closely. This varies from country to country, but the study provides a basis for international adjustments.

The meta-analysis highlights the urgency, as inadequate controls can lead to serious complications. Early detection and treatment of secondary diseases are crucial for the prognosis. The researchers call for the integration of psychiatry and diabetology in order to better reach those affected. Such approaches could be implemented through training for doctors, interdisciplinary teams or digital tools.

Original Paper:

Disparities in diabetes treatment and monitoring for people with and without mental disorders: a systematic review and meta-analysis – The Lancet Psychiatry

Editor: X-Press Journalistenbüro GbR

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