Management of type 2 diabetes mellitus in people with severe mental illness: an online cross-sectional survey of healthcare professionals

Abstract

Objectives To establish healthcare professionals’ (HCPs) views about clinical roles, and the barriers and enablers to delivery of diabetes care for people with severe mental illness (SMI). Design Cross-sectional, postal and online survey. Setting Trusts within the National Health Service (NHS), mental health and diabetes charities and professional bodies. Participants HCPs who care for people with type 2 diabetes mellitus (T2DM) and/or SMI in the UK. Primary and secondary outcome measures The barriers, enablers and experiences of delivering T2DM care for people with SMI, informed by the Theoretical Domains Framework (TDF). Results Responders were 273 HCPs, primarily mental health nurses (33.7%) and psychiatrists (32.2%). Only 25% of respondents had received training in managing T2DM in people with SMI. Mental health professionals felt responsible for significantly fewer recommended diabetes care standards than physical health professionals (p<0.001). For those seeing diabetes care as part of their role, the significant barriers to its delivery in the regression analyses were a lack of knowledge (p=0.003); a need for training in communication and negotiation skills (p=0.04); a lack of optimism about the health of their clients (p=0.04) and their ability to manage T2DM in people with SMI (p=0.003); the threat of being disciplined (p=0.02); fear of working with people with a mental health condition (p=0.01); a lack of service user engagement(p=0.006) and a need for incentives (p=0.04). The significant enablers were an understanding of the need to tailor treatments (p=0.04) and goals (p=0.02) for people with SMI. Conclusions This survey indicates that despite current guidelines, diabetes care in mental health settings remains peripheral. Even when diabetes care is perceived as part of a HCP’s role, various individual and organisational barriers to delivering recommended T2DM care standards to people with SMI are experienced