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Diabetes and its prevention: pragmatic solutions for people with schizophrenia

Division of Medical Sciences, University of Birmingham and Birmingham Heartlands Hospital, Birmingham

Robert Peveler, MA DPhil FRCPsych

Community Clinical Sciences Division, University of Southampton, Southampton, UK

Correspondence: Dr S. C. L. Gough, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK. Tel: (0)121 4243593; fax: (0)121 4240593; e-mail: s.c.gough{at}bham.ac.uk

Declaration of interest S.G. has received financial support from Aventis, Eli Lilly, GSK, Novo Nordisk, Takeda and Novartis. R.P. has received financial support from Eli Lilly, AstraZeneca, Janssen-Cilag, Organon, Synthélabo, GSK, Pfizer, Wyeth and Lundbeck.

Background Patients with schizophrenia have an increased risk of developing diabetes. However, no pragmatic pathway of care has ever been proposed in order to identify individuals at risk and manage that risk effectively.

Aims To develop practical recommendations for the screening and management of diabetes in schizophrenia.

Method Staged review of evidence for the underrecognition of diabetesin people with schizophrenia and of the applicability of current screening strategies to this population. Recommendations for pragmatic pathways of care were developed.

Results All patients with schizophrenia should be screened and managed as a high-risk group for the development of diabetes. Psychiatrists should be responsible for screening and diabetes risk management; primary care physicians and/or diabetologists should be responsible for managing diabetes. Choice of antipsychotics should be based on achieving good control of schizophrenia, which may improve compliance with diabetes risk reduction strategies.

Conclusions Effective multidisciplinary team working should reduce the burden of diabetes in schizophrenia.

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