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Sachar A, Breslin N, Ng SM. An integrated care model for mental health in diabetes: Recommendations for local implementation by the Diabetes and Mental Health Expert Working Group in England. Diabet Med 2023; 40:e15029. [PMID: 36537609 DOI: 10.1111/dme.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT In 2019, NHS England and Diabetes UK convened an Expert Working Group (EWG) in order to develop a Model and recommendations to guide commissioning and provision of mental health care in diabetes pathways and diabetes care in mental health pathways. The recommendations are based on a combination of evidence, national guidance, case studies and expert opinion from across the UK and form other long term conditions. THE CASE FOR INTEGRATION There is good the evidence around the high prevalence of co-morbidity between diabetes and mental illness of all severities and, the poorer diabetes and mental health outcomes for patients when this co-morbidity exists. Detecting and managing the mental health co-morbidity improves these outcomes, but the evidence suggests that detection of mental illness is poor in the context of diabetes care in community and acute care settings and that when it is detected, the access to appropriate mental health resource is variable and generally inadequate. THE MODEL OF INTEGRATED CARE FOR DIABETES The EWG developed a one-page Model with five core principles and five operational work-streams to support the delivery of integration, with examples of local case studies for local implementation. The five core principals are: Care for all-describing how care for all PWD needs to explore what matters to them and that emotional wellbeing is supported at diagnosis and beyond; Support and information-describing how HCPs should appropriately signpost to mental health support and the need for structured education programmes to include mental healthcare information; Needs identified-describing how PWD should have their mental health needs identified and acted on; Integrated care-describing how people with mental illness and diabetes should have their diabetes considered within their mental health care; Specialist care-describing how PWD should be able to access specialist diabetes mental health professionals. The five cross cutting work-streams for operationalising the principles are: Implementing training and upskilling of HCPs; Embedding mental health screening and assessment into diabetes pathways; Ensuring access to clear, integrated local pathways; Ensuring addressing health inequalities is incorporated at every stage of service development; Improving access to specialist mental health services through commissioning. DISCUSSION AND CONCLUSIONS The Model can be implemented in part or completely, at an individual level, all the way up to system level. It can be adapted across the life span and the UK, and having learnt from other long term conditions, there is a lot of transferability across all long term conditions There is an opportunity for ICBs to consider economies of scale across multiple long term conditions for which there will be a significant overlap of patients within the local population. Any local implementation should be in co-production with experts by experience and third sector providers.
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Affiliation(s)
- Amrit Sachar
- Liaison Psychiatry Service, Charing Cross and Hammersmith Hospitals, Imperial College Healthcare NHS Trust and West London NHS Trust, London, United Kingdom
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, United Kingdom
- Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom
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Zabell V, Rønne ST, Høgsgaard D, Jørgensen R, Gaede PH, Arnfred SM. Interventions involving own treatment choice for people living with coexisting severe mental illness and type 1 or 2 diabetes: A scoping review. Diabet Med 2021; 38:e14626. [PMID: 34152639 DOI: 10.1111/dme.14626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/19/2021] [Indexed: 12/16/2022]
Abstract
AIM The objective of this scoping review was to summarize, understand and provide an overview of the empirical literature on interventions involving own treatment choice for people with coexisting diabetes (type 1 and 2) and severe mental illness (SMI). METHODS This scoping review undertook a systematic literature assessment. Searches were performed in MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, the Cochrane Library and grey literature (OpenGrey, Google Scholar and Danish Health and Medicine Authority databases). Publications from 2000 to July 2020 were of interest. Studies were included if they involved the users' own choice of treatment. INCLUDED STUDIES RCT, intervention, cohort and case-based studies. RESULTS A total of 4320 articles were screened, of which nine were included. The review identified eight studies from the United States and one from Canada testing different interventions for people with SMI and diabetes (one diabetes education program, five randomized controlled trials, one retrospective cohort study, one naturalistic intervention program and one case vignette). The interventions described in the nine articles involved service users, the majority incorporated individualized healthcare plans, and all interventions were based on multidisciplinary teamwork. CONCLUSIONS Research in the area is limited. Care management interventions tend to focus on a single condition, paradoxically excluding SMI during enrolment. Interventions aimed at people with both conditions often prioritize one condition treatment leading to an unbalanced care.
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Affiliation(s)
- Vicki Zabell
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina T Rønne
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Høgsgaard
- Primary and eHealth Care, Slagelse, Denmark
- Faculty of Public Health, University of Southern Denmark, Odense, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - Peter H Gaede
- Department of Internal Medicine Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Faculty of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sidse M Arnfred
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Doherty AM, Herrmann-Werner A, Rowe A, Brown J, Weich S, Ismail K. Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study. BMJ Open Diabetes Res Care 2021; 9:9/1/e001934. [PMID: 33452059 PMCID: PMC7813360 DOI: 10.1136/bmjdrc-2020-001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/02/2020] [Accepted: 12/20/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This study examines the feasibility of conducting diabetes-focused cognitive-behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes. RESEARCH DESIGN AND METHODS We used a pre-post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS). RESULTS We screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference -6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved. CONCLUSIONS It would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.
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Affiliation(s)
- Anne M Doherty
- Psychiatry, University College Dublin, Dublin, Ireland
- Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anne Herrmann-Werner
- Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tubingen, Tubingen, Baden-Württemberg, Germany
| | | | - Jennie Brown
- Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Scott Weich
- Mental Health Research Unit, The University of Sheffield, Sheffield, UK
| | - Khalida Ismail
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Pastor A, Conn J, MacIsaac RJ, Bonomo Y. Alcohol and illicit drug use in people with diabetes. Lancet Diabetes Endocrinol 2020; 8:239-248. [PMID: 31958403 DOI: 10.1016/s2213-8587(19)30410-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 02/07/2023]
Abstract
As the prevalence of type 1 and type 2 diabetes increases and population-level patterns of alcohol and illicit drug use evolve, clinicians will continue to encounter people with diabetes whose substance use is affecting health outcomes. Substance use contributes substantially to the population-level prevalence of cardiovascular events, cerebrovascular events, cancers, mental health conditions, road trauma, and domestic violence. Alcohol and drug use also have a measurable effect on diabetes incidence and the development of both acute and chronic diabetes-related complications. In this Review, we examine the effect of alcohol and illicit drug use on people with type 1 or type 2 diabetes. We describe evidence for substance use as a risk factor for new-onset diabetes, prevalence of use in people with diabetes, evidence linking substance use with diabetes-related health outcomes, and evidence on the management of these co-occurring conditions.
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Affiliation(s)
- Adam Pastor
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
| | - Jennifer Conn
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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Solomons L. ‘Too often missing’ report findings: let's start with what our patients are telling us. PRACTICAL DIABETES 2019. [DOI: 10.1002/pdi.2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Dart AB, Wicklow B, Blydt-Hansen TD, Sellers EAC, Malik S, Chateau D, Sharma A, McGavock JM. A Holistic Approach to Risk for Early Kidney Injury in Indigenous Youth With Type 2 Diabetes: A Proof of Concept Paper From the iCARE Cohort. Can J Kidney Health Dis 2019; 6:2054358119838836. [PMID: 31041107 PMCID: PMC6477761 DOI: 10.1177/2054358119838836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Indigenous youth with type 2 diabetes (T2D) are disproportionately affected
by early onset albuminuria and are at high risk of kidney failure in early
adulthood. Traditional biological approaches have failed to fully explain
the renal morbidity seen in this population. The improving
renal Complications in Adolescents with
type 2 diabetes through REsearch cohort (iCARE) study was
therefore designed in collaboration with patients, to more holistically
evaluate risk factors for renal morbidity. We hypothesize that both
biological factors and mental health influence renal outcomes, mediated via
inflammatory pathways. Objective: The objective of this study was to evaluate the iCARE analytic framework
which evaluates relationships between biological factors, mental health,
inflammation, and albuminuria utilizing a structural equation modeling (SEM)
approach. Methods: The first 187 youth with T2D (10-25 years) from the Manitoba iCARE cohort are
presented here to evaluate our theoretical and analytic framework. An SEM
was chosen to evaluate the statistical significance of proposed
associations. The primary outcome was a nonorthostatic urine
albumin:creatinine ratio ≥2 mg/mmol. Main exposures (ie, latent factors)
included psychological health (distress, perceived stress, positive mental
health and resilience), hypertension (24 hour monitored), and inflammatory
markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR],
fibrinogen). Hemoglobin A1c (HbA1c) and duration of diabetes were
covariates. Results: Within the initial cohort (median age = 15 years, duration of diabetes = 2.3
years, 66.8% female), 30.5% (n = 57) had nonorthostatic albuminuria (ALB),
and the majority of ALB was persistent (confirmed in 2/3 samples over a
6-month period; n = 47). Youth with ALB had higher HbA1c (10.9% vs 8.9%;
P < .001), more hypertension (94.2% vs 78·2%;
P = .02), longer duration of diabetes (3.4 vs 2.4
years; P = .01), higher distress (9.2 vs 7.3;
P = .02), and stress scores (28.7 vs 26.4;
P = .03), and elevated inflammatory markers (CRP: 4.9
vs 3.1 mg/L; P = .01, fibrinogen: 3.7 vs 3.3 µmol/L;
P = .02). Factors directly associated with ALB in the
SEM were hypertension (0.28; P = .001), inflammation (0.41;
P < .001), and HbA1c (0.50; P <
.001). Psychological health was independently associated with inflammation
(−0.20; P < .001) but not directly associated with
ALB. Conclusions: Albuminuria is highly prevalent in Indigenous youth with T2D. This
preliminary analysis supports a theoretical framework linking glycemic
control, hypertension, and inflammation, potentially mediated by
psychological factors with albuminuria. These data support the need for more
holistic models of evaluation and care for youth with T2D and multifactorial
interventions to prevent complications.
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Affiliation(s)
- Allison B Dart
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Team, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Brandy Wicklow
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Team, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, The University of British Columbia, Winnipeg, MB, Canada
| | - Elizabeth A C Sellers
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Team, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Sayma Malik
- Department of Clinical Psychology, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Atul Sharma
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Jonathan M McGavock
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Team, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
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