For many different reasons, people with schizophrenia and schizoaffective disorders have a greater risk of type 2 diabetes.  The prevalence of type 2 diabetes in people with schizophrenia is twice that of the general population.

This review looked for evidence of the efficacy of interventions to help people with schizophrenia manage their diabetes.

Clinical question

In people with type 2 diabetes and schizophrenia or schizo-affective disorder, what lifestyle interventions improve self-management?

The scope included education, diet and exercise interventions that addressed the challenges associated with schizophrenia, such as decreased cognitive ability, reduced motivation and limited access to resources.  The outcomes of interest were HbA1c, fasting blood glucose (FBG) and body mass index (BMI) or weight lost.

The evidence

Four articles were identified for inclusion in the review.  Two of these were randomised trials, two were observational studies with no control group.  However, the reviewers considered the studies to be of good or excellent methodological quality.

The randomised trials of an outpatient education programme found that participants lost weight whilst the control group gained weight.  This difference was statistically significant.  Improvements in HbA1c were not statistically significant.

Appraisal hints

If you read the full-text of this review, you may like to bear in mind the following issues:

• The literature search not include EMBASE and may have missed relevant studies
• Selection criteria were defined in advance and applied by two independent reviewers
• There was considerable heterogeneity between the studies in terms of setting and interventions
• The randomised trial was conducted on self-selected volunteers, and may represent a sub-set of highly motivated patients when compared with the general population.
• The trial populations were all “older adults” (mean age 44-53 years)
• Details of the specific educational programmes are not provided in the review
• The impact of antipsychotic drugs needs to be taken into account when applying this evidence.  Would these findings translate to your patients or setting?

Links

Cimo A, Stergiopoulos E, Cheng C, Bonato S, Dewa CS.  Effective lifestyle interventions to improve type II diabetes self-management for those with schizophrenia or schizoaffective disorder: a systematic review. BMC Psychiatry. 2012 Mar 23;12(1):24. [Epub ahead of print]