SAT121 Challenging Health Disparities In Mental Illness: Addressing Diabetes And Metabolic Disease
Authors: Chen Roger , Finneran Catherine , Higgins Devlin , Lum Cheryl , Allen Jean 
Published: October 2023

Disclosure: R. Chen: Speaker; Self; Boehringer Ingelheim, Novo Nordisk, AstraZeneca, Eli Lilly & Company. C. Finneran: None. D. Higgins: None. C. Lum: None. J. Allen: None.

Introduction: Having a severe mental illness such as schizophrenia confers a substantial increase in the prevalence of diabetes, obesity and premature cardiovascular disease. These health disparities, particularly in diabetes care, have led to a life expectancy in this vulnerable group which is up to 25-30 years less than that of the general population. There are several potential causes for these health disparities. These include poor health literacy, poor recognition by clinicians of the relationship between mental illness and diabetes, the persistent separation of mental and physical health care as well as the adverse metabolic effects of antipsychotics. Despite numerous national and international guidelines, patients frequently have difficulties in accessing appropriate metabolic health care and negotiating health pathways. There is little evidence that these health disparities are being addressed in a systematic way. We sought to challenge the traditional separation of mental and physical health care and to address these health disparities. Aims: To establish an integrated multidisciplinary service to manage metabolic health in this vulnerable population. Methods: A collaborative pilot program between diabetes and mental health units has a clinical team of exercise physiologist, dietitian, endocrinologist, diabetes educator and mental health nurse. A model of care has been developed where all patients assessed by the mental-health unit are routinely screened with a tool which assesses anthropometry (including weight, height, BMI) and biochemistry (including HbA1c. lipids and renal function). Patients are managed in weekly multidisciplinary clinics based in the mental health unit, with defined referral criteria (type 2 diabetes, metabolic syndrome, pre-diabetes, dyslipidaemia, hypertension and weight-gain). Results: From June 2020 to September 2022, we assessed 194 patients with 421 occasions of service. 49 patients (25%) had diabetes, 18 had pre-diabetes and 31 had newly-diagnosed diabetes. 91 had metabolic syndrome, 94 were smokers, 123 had dyslipidaemia and 17 were of first nations background. We have also provided education to mental health staff to upskill knowledge on diabetes. Conclusions: Collaboration between mental health and diabetes clinicians has been essential to coordinate a patient-centred service whereby all patients meeting the referral criteria are assessed. New diagnoses of diabetes would potentially have been missed and patients with established diabetes have been assessed whilst they would not have received any diabetes care without the establishment of this clinic. These diabetes health disparities are particularly startling in light of the benefits of early multifactorial intervention in preventing diabetes related complications.

Presentation: Saturday, June 17, 2023