TY - JOUR T1 - Diabetes outcomes in people with severe mental illness JF - British Journal of General Practice JO - Br J Gen Pract SP - 166 LP - 167 DO - 10.3399/bjgp18X695381 VL - 68 IS - 669 AU - Alan Cohen AU - Mark Ashworth AU - Andrew Askey AU - Khalida Ismail Y1 - 2018/04/01 UR - http://bjgp.org/content/68/669/166.abstract N2 - In March 2018, GPs in England and Wales should have received information on the quality of care experienced by their patients with diabetes based on the findings of the National Diabetes Audit (NDA).1 The NDA is one of the largest comprehensive annual clinical audits in the world, integrating data from both primary and secondary care sources. For the first time, outcome data from the population that have diabetes will be presented comparing patients who also have a severe mental illness (SMI) with those that do not have an SMI. These patients will have been identified through their inclusion in the ‘Mental Health’ register in the Quality and Outcomes Framework (QOF) and typically include those with psychotic disorders and bipolar affective disorder.Patients with SMI die 10–20 years earlier than those without SMI, and long-term conditions contribute substantially to the mortality gap.2 The causes of this premature mortality are complex and inter-related: diabetes is 2–3 times more common among people with SMI than the general population;3 antipsychotic medication is both obesogenic and diabetogenic;4,5 antipsychotic medication is also thrombophilic6 and up to 70% of people with schizophrenia smoke. People with SMI are more likely to be unemployed, have poor accommodation and require state benefits; the disabling nature of SMI makes it more difficult to adhere to medication regimens, to keep review appointments, to lose weight and take regular exercise7 — all of which would improve health outcomes. Organisational barriers related to parallel services that do not integrate physical and medical care results in the most vulnerable patients falling between organisational ‘nets’. Overall, the combination of diabetes with psychiatric comorbidities, medication side-effects, and organisational factors mean that it is hardly surprising that diabetes is one of the major causes of early death in this group. … ER -