Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK.
Department of Cancer Studies and Molecular Medicine, Infirmary Close, University of Leicester, Leicester LE1 5WW, UK.
Nat Rev Endocrinol. 2015 Feb;11(2):79-89. doi: 10.1038/nrendo.2014.203. Epub 2014 Dec 2.
The prevalence of diabetes mellitus is twofold to threefold higher in people with severe mental illness (SMI) than in the general population, with diabetes mellitus affecting ∼12% of people receiving antipsychotics. The consequences of diabetes mellitus are more severe and frequent in people with SMI than in those without these conditions, with increased rates of microvascular and macrovascular complications, acute metabolic dysregulation and deaths related to diabetes mellitus. Multiple complex mechanisms underlie the association between diabetes mellitus and SMI; these mechanisms include genetic, environmental and disease-specific factors, and treatment-specific factors. Although antipsychotics are the mainstay of treatment in SMI, a causative link, albeit of uncertain magnitude, seems to exist between antipsychotics and diabetes mellitus. The principles of managing diabetes mellitus in people with SMI are similar to those for the general population and should follow currently established treatment algorithms. Lifestyle interventions are needed to reduce incident diabetes mellitus. In addition, improved uptake of opportunities to screen for this disease will reduce the high prevalence of undiagnosed diabetes mellitus. Currently, people with SMI receive poorer treatment for diabetes mellitus than the general population. Thus, health-care professionals in primary care, diabetes mellitus services and mental health teams have a responsibility to ensure that patients with SMI are not disadvantaged.
严重精神疾病患者（SMI）的糖尿病患病率比一般人群高 2 至 3 倍，接受抗精神病药物治疗的患者中约有 12%患有糖尿病。与没有这些疾病的患者相比，SMI 患者的糖尿病后果更为严重和常见，其微血管和大血管并发症、急性代谢紊乱以及与糖尿病相关的死亡率均更高。糖尿病与 SMI 之间的关联涉及多种复杂机制，包括遗传、环境和疾病特异性因素以及治疗特异性因素。尽管抗精神病药物是 SMI 治疗的主要手段，但抗精神病药物与糖尿病之间似乎存在因果关系，尽管其程度尚不确定。SMI 患者的糖尿病管理原则与一般人群相似，应遵循当前既定的治疗算法。需要进行生活方式干预以减少新发糖尿病。此外，增加筛查机会可降低未确诊糖尿病的高患病率。目前，SMI 患者接受的糖尿病治疗不如一般人群，因此，初级保健、糖尿病服务和精神卫生团队的医疗保健专业人员有责任确保 SMI 患者不会受到不利影响。
