Bellass Sue, Taylor Johanna, Han Lu, Prady Stephanie L, Shiers David, Jacobs Rowena, Holt Richard Ian Gregory, Radford John, Gilbody Simon, Hewitt Catherine, Doran Tim, Alderson Sarah L, Siddiqi Najma
Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, United Kingdom.
Department of Health Sciences, University of York, York, United Kingdom.
JMIR Res Protoc. 2019 Sep 6;8(9):13407. doi: 10.2196/13407.
The average life expectancy for people with a severe mental illness (SMI) such as schizophrenia or bipolar disorder is 15 to 20 years less than that for the population as a whole. Diabetes contributes significantly to this inequality, being 2 to 3 times more prevalent in people with SMI. Various risk factors have been implicated, including side effects of antipsychotic medication and unhealthy lifestyles, which often occur in the context of socioeconomic disadvantage and health care inequality. However, little is known about how these factors may interact to influence the risk of developing diabetes and poor diabetic outcomes, or how the organization and provision of health care may contribute.
This study aims to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with SMI.
This study will employ a concurrent mixed methods design combining the interrogation of electronic primary care health records from the Clinical Practice Research Datalink (CPRD GOLD) with qualitative interviews with adults with SMI and diabetes, their relatives and friends, and health care staff. The study has been funded for 2 years, from September 2017 to September 2019, and data collection has recently ended.
CPRD and linked health data will be used to explore the association of sociodemographics, illness, and health care-related factors with both the development and outcomes of type 2 diabetes in people with SMI. Experiences of managing the comorbidity and accessing health care will be explored through qualitative interviews using topic guides informed by evidence synthesis and expert consultation. Findings from both datasets will be merged to develop a more comprehensive understanding of diabetes risks, interventions, and outcomes for people with SMI. Findings will be translated into recommendations for interventions and services using co-design workshops.
Improving diabetes outcomes for people with SMI is a high-priority area nationally and globally. Understanding how risk factors combine to generate high prevalence of diabetes and poor diabetic outcomes for this population is a necessary first step in developing health care interventions to improve outcomes for people with diabetes and SMI.
ClinicalTrials.gov NCT03534921; https://clinicaltrials.gov/ct2/show/NCT03534921.
患有精神分裂症或双相情感障碍等严重精神疾病（SMI）的人群的平均预期寿命比总体人群短15至20年。糖尿病在很大程度上导致了这种不平等，在患有严重精神疾病的人群中，糖尿病的患病率是普通人群的2至3倍。各种风险因素都有涉及，包括抗精神病药物的副作用和不健康的生活方式，这些情况往往发生在社会经济劣势和医疗保健不平等的背景下。然而，对于这些因素如何相互作用以影响患糖尿病的风险和不良糖尿病结局，或者医疗保健的组织和提供方式可能如何产生影响，人们知之甚少。
本研究旨在确定糖尿病的决定因素，并探索患有严重精神疾病的人群中糖尿病结局的差异。
本研究将采用同步混合方法设计，将对临床实践研究数据链（CPRD GOLD）中的电子初级保健健康记录进行调查，与对患有严重精神疾病和糖尿病的成年人、他们的亲属和朋友以及医护人员进行定性访谈相结合。该研究已获得资助，为期2年，从2017年9月至2019年9月，数据收集最近已经结束。
CPRD和相关健康数据将用于探索社会人口统计学、疾病以及与医疗保健相关的因素与患有严重精神疾病的人群中2型糖尿病的发生和结局之间的关联。将通过使用基于证据综合和专家咨询的主题指南进行定性访谈，来探索管理合并症和获得医疗保健的经历。两个数据集的研究结果将合并，以更全面地了解患有严重精神疾病的人群的糖尿病风险、干预措施和结局。研究结果将通过共同设计研讨会转化为干预措施和服务的建议。
改善患有严重精神疾病的人群的糖尿病结局是国家和全球的一个高度优先领域。了解风险因素如何结合导致该人群中糖尿病的高患病率和不良糖尿病结局，是制定医疗保健干预措施以改善患有糖尿病和严重精神疾病的人群的结局的必要第一步。
ClinicalTrials.gov NCT03534921；https://clinicaltrials.gov/ct2/show/NCT03534921
