It is possible to reduce excess mortality among psychiatric patients with diabetes – University of Copenhagen

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08 January 2016

It is possible to reduce excess mortality among psychiatric patients with diabetes

Diabetes

A study from University of Copenhagen reveals that an individually adjusted treatment can save lives among patients with type-2 diabetes who also suffer a serious psychological illness.

Patients who suffer diabetes and a psychological illness have a high degree of excess mortality compared to other diabetes patients. It is, however, possible to reduce the mortality rate through relatively simple measures, i.e. by ensuring that the treatment administered by their GP is custom made to suit their individual needs, as is revealed in a new analysis of a study from University of Copenhagen. The article was just published in the scientific journal, General Hospital Psychiatry.

For 19 years, the project “Diabetes Care in General Practice” followed 1381 patients who were treated by their GP from the time they were diagnosed with type-2 diabetes. Half of the GPs involved were taught how to improve the organising of the treatment of their diabetes patients. Among other things, they were taught to take the patients’ own wishes as a point of departure for providing the best possible treatment. Of the 1381 patients with diabetes, 179 were also diagnosed with a serious psychological illness, either before they were diagnosed with diabetes or sometime during the subsequent 19 years.

“We find an overrepresentation of patients with diabetes in patients with a psychological illness and on average, their life span is 20 years shorter. This project affirms that there is excess mortality in patients who suffer both diabetes and a serious psychological illness compared to patients who suffer diabetes but no psychological illness,” says Doctor and PhD student, Julie Rask Larsen, from the Faculty of Health and Medical Science at the University of Copenhagen. She is behind the new analysis.

The analysis also shows that if GPs offer their patients an individually adjusted treatment, the mortality rate is significantly reduced.

“In the group of patients with a serious psychological illness who were offered an individually adjusted diabetes treatment by their GP, the mortality rate was reduced by 33% and the risk of suffering a coronary was halved. There was no change in the mortality rate of patients who received the individually adjusted treatment but who did not already have or later get a serious psychological illness. The risk of these patients suffering a coronary was reduced by 20%,” Julie Rask Larsen elaborates.

According to Head of Project, Professor of General Medicine, Niels de Fine Olivarius, the bar is not always set high enough in the treatment of diabetes patients who also suffer a psychological illness, even if the GPs set out with the intent of helping their patients as much as possible. As part of the study, the GPs allowed their patients to choose between good, acceptable or indeed, and preferably only for short periods of time, poor control of cholesterol, blood sugar and blood pressure.

“Patients who are pushed too hard may lose motivation and GPs must therefore take their point of departure in each individual’s specific life situation. Are they on top of their situation right now? You cannot simply tell people to change their lives. If you’ve just lost your job or been divorced or been diagnosed with a serious psychological illness, you may not be particularly motivated to do something about your diabetes. And it’s at times like this that it’s important that GPs maintain patient contact, as opposed to pushing their patients away, as this will allow them to reinitiate a dialogue at a later point in time,” Niels de Fine Olivarius concludes.

Contact:
Professor Niels de Fine Olivarius, mail:
olivarius@sund.ku.dk, phone: +45 35 32 71 60