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Pharmacological management of diabetes in severe mental illness: a comprehensive clinical review of efficacy,safety and tolerability |
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| Authors: | John Lally Aonghus O’ Loughlin Brendon Stubbs Allys Guerandel Donal O’Shea Fiona Gaughran |
| Institution: | 1. Department of Psychosis Studies, Institute of Psychiatry, Psychology &2. Neuroscience, King’s College London, London, UK;3. Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent’s University Hospital, Dublin, Ireland;4. Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland;5. Department of Medicine, Bon Secours Hospital, Galway, Ireland;6. Psychological Medicine Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK;7. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London,UK;8. Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent’s University Hospital, Dublin, Ireland;9. Education Research Centre, St. Vincent’s University Hospital, Dublin, Ireland;10. Endocrine Unit, St Columcille’s Hospital, Loughlinstown, County Dublin, Ireland;11. National Psychosis Service, South London and Maudsley NHS Foundation trust, London, UK |
| Abstract: | Introduction: The increased prevalence of Type 2 diabetes mellitus (T2DM) in severe mental illness (SMI) contributes to increased cardiovascular morbidity and reduced life expectancy for people with SMI. Areas covered: In the present clinical review, we summarize the efficacy, safety and tolerability of selected diabetic pharmacotherapy options in SMI and discuss the quality and strength of evidence. Expert commentary: General principles for treating T2DM in SMI involve identifying treatments which promote weight loss and which have low or no risk of hypoglycemia. Patient engagement in decision making about treatment choices is an important factor to ensure adherence and successful use of the chosen therapy. The first line therapeutic option for T2DM in SMI for which there is most evidence is metformin. Based on general population data, second line treatment options in combination with metformin to achieve glycated haemoglobin treatment goals include GLP-1R agonists, DPP-4 inhibitors, sulphonylureas, SGLT2 inhibitors, pioglitazone and insulin, with most evidence for the use of GLP-1R agonists in SMI. Alongside efficacy and tolerability, treatment for T2DM in SMI should be considered on a patient-tailored basis. |
| Keywords: | Schizophrenia psychosis antipsychotics metformin GLP-1R agonists |