Mental Disorders Linked to Inappropriate Diabetes Monitoring and GLP-1 Therapy: The Lancet
Germany: Researchers have found in a new study that mental disorders are associated with lower rates of appropriate diabetes monitoring and reduced use of GLP-1 agonist therapy. These gaps in care may play a significant role in the increased mortality seen in individuals with mental disorders, underscoring the importance of addressing healthcare inequities in this vulnerable population.
In a comprehensive systematic review and meta-analysis published in The Lancet Psychiatry, Elias Wagner from the Evidence-based Psychiatry and Psychotherapy unit, Faculty of Medicine, University of Augsburg, Germany, along with colleagues, examined whether people living with both diabetes and mental disorders receive the same standard of diabetes care as those without mental health conditions. The analysis highlights persistent and widespread disparities in diabetes management across mental health diagnoses and healthcare settings.
The researchers analysed data from 49 observational studies, including 42 cohort and seven case-control studies, encompassing more than 5.5 million individuals with diabetes. Of these, over 838,000 people—around 15%—had a diagnosed mental disorder, identified primarily using ICD-9 or ICD-10 criteria. The study population spanned Asia, Europe, North America, and Australasia, with most included studies rated as high quality using the Newcastle–Ottawa Scale.
The primary outcome assessed was a composite indicator of diabetes quality of care, reflecting whether patients received any recommended monitoring or treatment measures. These included routine assessments such as HbA1c testing, blood pressure measurement, kidney and lipid evaluations, retinal screening, foot examinations, and documentation of body mass index and smoking status. Secondary outcomes focused on individual monitoring indicators and specific diabetes treatments.
The key findings were as follows:
- Individuals with any mental disorder were significantly less likely to receive recommended diabetes monitoring compared with those without mental health conditions.
- Reduced monitoring was observed across multiple essential measures, including HbA1c testing, retinal examinations, lipid and cholesterol assessments, renal investigations, and foot surveillance.
- These patterns indicate consistent gaps in routine diabetes follow-up among people living with mental disorders.
- In terms of treatment, individuals with mental disorders had higher odds of being prescribed insulin therapy.
- In contrast, they were markedly less likely to receive newer diabetes treatments such as GLP-1 receptor agonists.
- The lower use of GLP-1 agonists points to possible barriers in accessing innovative therapies that provide additional metabolic and cardiovascular benefits.
- Disparities in diabetes care were observed across a broad spectrum of mental disorders, including depression, schizophrenia, bipolar disorder, substance use disorders, anxiety disorders, and dementia.
- Differences in the quality of care were more pronounced in men than in women, highlighting layered inequities within already vulnerable populations.
According to the authors, these gaps in diabetes monitoring and treatment may contribute to the well-documented excess cardiometabolic mortality seen in people with mental disorders. They emphasise the need for better integration between mental health services, primary care, and preventive healthcare systems to ensure equitable diabetes management.
The researchers conclude that improving access to routine diabetes monitoring and modern therapies for people with mental disorders could help reduce avoidable complications and mortality. They also call for large, well-designed trials to evaluate targeted care models and quality improvement strategies aimed at closing this critical healthcare gap.
Reference: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2825%2900332-3/fulltext
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