Diabetic patients with psychiatric illness.
OBJECTIVE
Diabetic patients with co-morbid mental illness are commonly encountered in clinical practice. Not only are diabetes and mental illness both common in the general population, but rates of diabetes are significantly higher in individuals with psychiatric disorders. This paper reviews literature related to the interplay between these pathologies and the consequent clinical challenge faced by physicians.


METHODS
A systematic review was conducted, examining specific aspects of psychiatric illness which may affect diabetic outcomes.


RESULTS
Decreased adherence is a feature of many psychiatric conditions, and can have a major effect on diabetic management and development of long term complications. Glycemic regulation may also be complicated by physiologic changes affecting carbohydrate metabolism. Patterns of counter-regulatory hormone secretion are altered in many psychiatric conditions, which may necessitate an altered diabetic treatment regimen. Further difficulties arise as many psychiatric medications have adverse metabolic effects.


CONCLUSIONS
Diabetic patients with mental illness present a unique clinical challenge as a result of issues related to behaviour, physiology and medications. Clinicians should be able to recognize "problem patients" who may in fact have undiagnosed, treatable, psychiatric pathology. In patients carrying existing diagnoses, complicating factors to diabetic control should be recognized, and steps taken to minimize adverse effects.
Myers
Kenneth A
KA
Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada. kmyers@ucalgary.ca
Edwards
Alun L
AL
D050260:Carbohydrate Metabolism / Q000502:physiology; D002491:Central Nervous System Agents / Q000008:administration & dosage / Q000009:adverse effects; D048909:Diabetes Complications / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D004347:Drug Interactions; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D010349:Patient Compliance / Q000706:statistics & numerical data
D002491:Central Nervous System Agents; D007004:Hypoglycemic Agents