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An audit of diabetes mellitus management within a specialist secure psychiatric hospital

Published online by Cambridge University Press:  19 October 2011

Marlene Kelbrick ,
Ayesha Muthu-Veloe  and
Marco Picchioni
Marlene Kelbrick*
Affiliation:
Associate Specialist, Men’s Service, St Andrew’s Hospital, Northampton, UK
Ayesha Muthu-Veloe
Affiliation:
Associate Specialist, Men’s Service, St Andrew’s Hospital, Northampton, UK
Marco Picchioni
Affiliation:
Senior Lecturer and Honorary Consultant Forensic Psychiatrist, Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King’s College, London, UK St Andrew’s Academic Centre, Northampton, UK
*
Correspondence to: Dr Marlene Kelbrick, Billing Road, Northampton, NN1 5DG. E-mail: [email protected]
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Abstract

Background: People with severe mental illness are at an increased risk of physical health problems including diabetes.

Aims: To identify the proportion of patients with diabetes in specialist secure psychiatric care, establish current practice in diabetes care and management, and clarify the role of the psychiatric medical team versus the on-site general practitioner.

Method: Hospital-wide data collection from electronic and paper case notes of all identified diabetic patients. Audit standards were based on current National Institute for Clinical Excellence guidelines.

Results: 64 out of 548 patients (11.7%) were identified with a diagnosis of diabetes. 18 (28%) of these patients had an individual care plan to address their diabetic management and risk. The majority of patients had regular blood glucose and HbA1c monitoring.

Clinical implications: Patients should receive regular structured education sessions, regular feedback about their own management, and individual care plans that include the management of common and potentially life threatening complications. These are essential components of providing good quality diabetes care. Clinical audit may provide a means of identifying and rectifying problems in relation to diabetes care in long-stay psychiatric inpatients.

Keywords

Diabetesantipsychoticssevere mental illnesspsychiatric inpatients
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 2 , August 2012 , pp. 88 - 95
Copyright
Copyright © NAPICU 2011

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References

Aleman, A., Agrawal, N., Morgan, K.D. and David, A.S. (2006) Insight in psychosis and neuropsychological function: meta-analysis. The British Journal of Psychiatry. 189: 204–212.CrossRefGoogle ScholarPubMed
Amador, X.F. and David, A.S. (2004) Insight and Psychosis: Awareness of illness in schizophrenia and related disorders, 2nd ed.Oxford University Press.CrossRefGoogle Scholar
American Diabetes Association (2003) Peripheral arterial disease in people with diabetes. Diabetes Care. 26(12): 3333–3341.CrossRefGoogle Scholar
Brown, S., Inskip, H. and Barraclough, B. (2000) Causes of excess mortality of schizophrenia. British Journal of Psychiatry. 177: 212–217.CrossRefGoogle ScholarPubMed
Bushe, C. and Holt, R. (2004) Prevalence of diabetes and impaired glucose tolerance in patients with schizophrenia. British Journal of Psychiatry. 184(47): 67–71.CrossRefGoogle Scholar
Citrome, L., Jaffe, A., Levine, J., Allingham, B. and Robinson, J. (2004) Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients. Psychiatric Services. 55(9): 1006–1013.CrossRefGoogle ScholarPubMed
Citrome, L., Blonde, L. and Damatarca, C. (2005) Metabolic issues in patients with severe mental illness. Southern Medical Journal. 98(7): 729–732.CrossRefGoogle ScholarPubMed
Cormac, I., Rerriter, M., Benning, R. and Saul, C. (2005) Physical health and health risk factors in a population of long-stay psychiatric patients. Psychiatric Bulletin. 29: 18–20.CrossRefGoogle Scholar
Department of Health (2008) Five years on: Delivering the diabetes national service framework. DOH.Google Scholar
Diabetes UK (2007) Diabetes Heartache: The hard reality of cardiovascular care for people with diabetes. www.diabetes.org.uk/Documents/News/Heartache_report07.pdfGoogle Scholar
Dickerson, F.B., Goldberg, R.W., Brown, C.H., Kreyenbuhl, J.A., Wohlheiter, K., Fang, L., Medoff, D. and Dixon, L.B. (2005) Diabetes knowledge among persons with serious mental illness and type 2 diabetes. Psychosomatics. 46: 418–424.CrossRefGoogle ScholarPubMed
Fowler, M.J. (2008) Microvascular and macrovascular complications of diabetes. Clinical Diabetes. 26(2): 77–82.CrossRefGoogle Scholar
Gonzalez, E.L.M., Johansson, S., Wallander, M.A. and Rodriguez, L.A.G. (2009) Trends in the prevalence and incidence of diabetes in the UK: 1996–2005. Journal of Epidemiological Community Health. 63: 332–336.CrossRefGoogle ScholarPubMed
Gough, S. and Peveler, R. (2004) Diabetes and its prevention: pragmatic solutions for people with schizophrenia. British Journal of Psychiatry 184(47): 106–111.CrossRefGoogle Scholar
Harris, E.C. and Barraclough, B. (1998) Excess mortality of mental disorder. British Journal of Psychiatry 173: 11–53.CrossRefGoogle ScholarPubMed
Holt, R.I.G., (2004) Diagnosis, epidemiology and pathogenesis of diabetes mellitus: an update for psychiatrists. British Journal of Psychiatry. 184(47): 55–63.CrossRefGoogle Scholar
Holt, R.I.G. (2006) Review: severe mental illness, antipsychotic drugs and the metabolic syndrome. The British Journal of Diabetes & Vascular Disease. 6(5): 199–205.CrossRefGoogle Scholar
Iqbal, N., Morgan, C., Maksoud, H. and Idris, I. (2008) Improving patients’ knowledge on the relationship between HbA1c and mean plasma glucose improves glycaemic control among persons with poorly controlled diabetes. Annals of Clinical Biochemistry. 45: 504–507.CrossRefGoogle ScholarPubMed
Kaholokula, J.K., Schrimer, T.N. and Elting, D. (2004) Identifying and prioritizing diabetes care issues among mental health professionals of a multi-ethnic, state psychiatric hospital. Diabetes Spectrum. 17(2): 123–128.CrossRefGoogle Scholar
Koev, D.J., Tankova, T.I. and Kozlovski, P.G. (2003) Effect of structured group education on glycaemic control and hypoglycemia in insulin-treated patients. Diabetes Care. 26(1): 251.CrossRefGoogle ScholarPubMed
Llorente, M.D. and Urrutia, V. (2006) Diabetes, psychiatric disorders, and the metabolic effects of antipsychotic medications. Clinical Diabetes. 24(1): 18–24.CrossRefGoogle Scholar
Makikyro, T., Karvonen, J., Hakko, H., Nieminen, P., Joukamaa, M., Isohanni, M., Jones, P. and Jarvelin, M. (1998) Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 northern Finland general population birth cohort. Public Health. 112(4): 221–228.Google ScholarPubMed
McCreadie, R.G. (2003) Diet, smoking and cardiovascular risk in people with schizophrenia. British Journal of Psychiatry. 183: 534–539.Google ScholarPubMed
National Health Service (2009) NICE and Diabetes: A summary of relevant guidelines. NHS.Google Scholar
National Institute for Clinical Excellence (2004) Type I Diabetes: Diagnosis and management of type 1 diabetes in adults. London: Royal College of Physicians.Google Scholar
National Institute for Clinical Excellence (2008) Type 2 Diabetes: National clinical guideline for management in primary and secondary care (update). London: Royal College of Physicians.Google Scholar
Renders, C.M., Valk, G.D., Griffin, S.J., Wagner, E.H., van Eijk, J.ThM. and Assendelft, W.J.J. (2001) Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care. 24(10): 1821–1833.CrossRefGoogle ScholarPubMed
Shandro, M.T., Pick, M.E., Gruinger, A. and Ryan, E.A. (2002) Diabetes care: interventions in the community. Diabetes Care. 25(5): 941.CrossRefGoogle ScholarPubMed