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Ojo O, Kalocsányiová E, McCrone P, Elliott H, Milligan W, Gkaintatzi E. Non-Pharmacological Interventions for Type 2 Diabetes in People Living with Severe Mental Illness: Results of a Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:423. [PMID: 38673334 PMCID: PMC11049919 DOI: 10.3390/ijerph21040423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND People with serious mental illnesses (SMIs) such as schizophrenia and bipolar disorder die up to 30 years younger than individuals in the general population. Premature mortality among this population is often due to medical comorbidities, such as type 2 diabetes (T2D). Being a disease directly related to diet, adverse lifestyle choices, and side effects of psychotropic medication, an effective approach to T2D treatment and management could be non-pharmacological interventions. This systematic review and meta-analysis (1) summarise the current evidence base for non-pharmacological interventions (NPI) for diabetes management in people living with SMI and (2) evaluate the effect of these interventions on diverse health outcomes for people with SMI and comorbid diabetes. METHODS Six databases were searched to identify relevant studies: PubMed (MEDLINE), PsycINFO, Embase, Scopus, CINAHL, and Web of Science. Studies were included if they reported on non-pharmacological interventions targeted at the management of T2D in people living with SMI. To be eligible, studies had to further involve a control group or report multiple time points of data in the same study population. Whenever there were enough interventions reporting data on the same outcome, we also performed a meta-analysis. RESULTS Of 1867 records identified, 14 studies were included in the systematic review and 6 were also eligible for meta-analysis. The results showed that there was a reduction, although not significant, in glycated haemoglobin (HbA1c) in the NPI group compared with the control, with a mean difference of -0.14 (95% CI, -0.42, 0.14, p = 0.33). Furthermore, NPI did not significantly reduce fasting blood glucose in these participants, with a mean difference of -17.70 (95% CI, -53.77, 18.37, p = 0.34). However, the meta-analysis showed a significant reduction in psychiatric symptoms: BPRS score, -3.66 (95% CI, -6.8, -0.47, p = 0.02) and MADRS score, -2.63 (95% CI, -5.24, -0.02, p = 0.05). NPI also showed a significant reduction in the level of total cholesterol compared with the control, with a mean difference of -26.10 (95% CI, -46.54, -5.66, p = 0.01), and in low-density lipoprotein (LDL) cholesterol compared with control, with a standardised mean difference of -0.47 (95% CI, -0.90, -0.04, p = 0.03). NPI did not appear to have significant effect (p > 0.05) on body mass index (BMI), health-related quality of life (HRQL), triglycerides, and high-density lipoprotein cholesterol compared with control. CONCLUSIONS This systematic review and meta-analysis demonstrated that NPI significantly (p < 0.05) reduced psychiatric symptoms, levels of total cholesterol, and LDL cholesterol in people with type 2 diabetes and SMI. While non-pharmacological interventions also reduced HbA1c, triglyceride, and BMI levels and improved quality of life in these people, the effects were not significant (p > 0.05).
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Affiliation(s)
- Omorogieva Ojo
- School of Health Sciences, Avery Hill Campus, University of Greenwich, London SE9 2UG, UK;
| | - Erika Kalocsányiová
- Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, Old Royal Naval College, University of Greenwich, Park Row, London SE10 9LS, UK; (E.K.); (P.M.); (E.G.)
| | - Paul McCrone
- Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, Old Royal Naval College, University of Greenwich, Park Row, London SE10 9LS, UK; (E.K.); (P.M.); (E.G.)
| | - Helen Elliott
- King’s Academy, 1-5 Hinton Road, London SE24 0HU, UK;
| | - Wendy Milligan
- School of Health Sciences, Avery Hill Campus, University of Greenwich, London SE9 2UG, UK;
| | - Evdoxia Gkaintatzi
- Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, Old Royal Naval College, University of Greenwich, Park Row, London SE10 9LS, UK; (E.K.); (P.M.); (E.G.)
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Goldstein FC, Saurman JL, Rodriguez AD, Vickers KL. Knowledge About COVID-19 Symptoms, Transmission, and Prevention: The Relationship With Cognitive Status in Older Adults. Gerontol Geriatr Med 2022; 8:23337214221123708. [PMID: 36105375 PMCID: PMC9465561 DOI: 10.1177/23337214221123708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: Advanced age poses an increased risk for cognitive
impairment, and therefore, poor knowledge regarding the risks associated with
COVID-19 may confer vulnerability. We administered a COVID-19 Knowledge
Questionnaire to older persons to evaluate the association between knowledge
regarding public health recommendations, and cognitive status as measured by the
Montreal Cognitive Assessment (MoCA). Method: Ninety-nine
participants completed a 22-item questionnaire about COVID-19 symptoms, risks,
and protective strategies, and they also completed the MoCA. Associations
between knowledge and cognitive status were examined via Spearman correlations.
Results: The mean (SD) age of participants was 72.6 (7.6)
years, and MoCA scores averaged 23.4 (4.5) points. Higher MoCA total scores were
significantly (p < .001) correlated with a greater number of
correct questionnaire responses. Higher Orientation and Memory Index scores were
moderately associated with an increased number of correct responses
(p < .001), with the Executive Index exhibiting a
significant albeit weaker association. MoCA Index scores assessing attention,
language, and visuospatial functioning were not significantly associated with
COVID-19 knowledge. Conclusions: Given the rapid transmission rate
of the SARS CoV-2 infections, COVID knowledge lapses will likely have
deleterious repercussions. Public health messages should ensure effective
acquisition and retention of COVID specific information, especially in
cognitively compromised older adults.
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Affiliation(s)
| | | | - Amy D Rodriguez
- Emory University School of Medicine, Atlanta, GA, USA.,Atlanta VA Medical Center, Decatur, GA, USA
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Babicz MA, Woods SP, Matchanova A, Medina LD, Podell K, Walker RL, Fetterman A, Rahman S, Johnson B, Thompson JL, Sullivan KL, Beltran-Najera I, Brooks J, Morales Y, Avci G. How did individual differences in neurocognition and health literacy influence the initial uptake and use of health-related information about COVID-19? J Clin Exp Neuropsychol 2021; 43:497-513. [PMID: 34142928 DOI: 10.1080/13803395.2021.1937579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The rapid development of coronavirus disease 2019 (COVID-19) into a pandemic required people to quickly acquire, evaluate, and apply novel complex health-related information about the virus and transmission risks. This study examined the potentially unique and synergistic roles of individual differences in neurocognition and health literacy in the early uptake and use of COVID-19 public health information.Method: Data were collected between April 23 and 21 May 2020, a period during which 42 out of 50 states were under a stay-at-home order. Participants were 217 healthy adults who completed a telephone-based battery that included standard tests of neurocognition, health literacy, verbal IQ, personality, and anxiety. Participants also completed measures of COVID-19 information-seeking skills, knowledge, prevention intentions, and prevention behaviors.Results: A series of hierarchical multiple regressions with data-driven covariates showed that neurocognition (viz, episodic verbal memory and executive functions) was independently related to COVID-19 knowledge (e.g. symptoms, risks) at a medium effect size, but not to information-seeking skills, prevention intentions, or prevention behaviors. Health literacy was independently related to all measured aspects of COVID-19 health information and did not interact with neurocognition in any COVID-19 health domain.Conclusions: Individual differences in neurocognition and health literacy played independent and meaningful roles in the initial acquisition of knowledge related to COVID-19, which is a novel human health condition. Future studies might examine whether neurocognitive supports (e.g. spaced retrieval practice, elaboration) can improve COVID-19-related knowledge and health behaviors in vulnerable populations.
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Affiliation(s)
| | | | | | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Kenneth Podell
- Department of Neurology, Methodist Hospital, Indianapolis, IN, USA
| | - Rheeda L Walker
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Adam Fetterman
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Samina Rahman
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Briana Johnson
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Kelli L Sullivan
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Jasmin Brooks
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Yenifer Morales
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Gunes Avci
- Department of Psychology, University of Houston, Houston, TX, USA
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Exploring the Outcomes of a Pilot Education Program Tailored for Adults With Type 2 Diabetes and Mental Illness in a Community Mental Health Care Setting. Can J Diabetes 2020; 44:461-472.e1. [PMID: 32792101 DOI: 10.1016/j.jcjd.2020.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES People with mental illness and type 2 diabetes are more likely to experience diabetes complications than the general population. Diabetes management can be improved with tailored lifestyle intervention content. The purpose of this pilot study was to investigate diabetes insights of mental health-care patients after participation in a tailored education intervention. METHODS A 12-session diabetes education program was created to address the learning needs and challenges that people with mental illness may experience. The program was assessed through conducting interviews with 6 participants combined with quantitative data to describe the population. Interviews were transcribed verbatim, assessed for quality and coded to identify relationships and meanings between identified themes. RESULTS Throughout the year of participation, blood sugar control and physical activity level improved for some and worsened for others. Weight remained stable and dietary intake patterns appeared to improve overall. Participants described the appropriateness of the teaching strategies and program structure developed, and all improved their understanding about diabetes and gained practical self-management knowledge. Opportunities for program improvement included extending care beyond the counselling room to address financial limitations, incorporating a practical activity component and creating opportunities for social support. Additionally, leaving some sessions as patient directed would further individualize education care. CONCLUSIONS Our study offers a concrete education program strategy that aligns with Diabetes Canada's self-management education guidelines to support the provision of diabetes care for people with mental illness. Modifying program delivery may help to curtail the increasing rates of morbidity and mortality currently observed in this population.
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Yang F, Ma Q, Liu J, Ma B, Guo M, Liu F, Li J, Wang Z, Liu M. Prevalence and major risk factors of type 2 diabetes mellitus among adult psychiatric inpatients from 2005 to 2018 in Beijing, China: a longitudinal observational study. BMJ Open Diabetes Res Care 2020; 8:8/1/e000996. [PMID: 32139600 PMCID: PMC7059541 DOI: 10.1136/bmjdrc-2019-000996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We aim to investigate the prevalence, trends, and major risk factors of type 2 diabetes mellitus (T2DM) among adult psychiatric inpatients in Beijing, China. RESEARCH DESIGN AND METHODS We did a longitudinal observational study using data from the Beijing Municipal Commission of Health and Family Planning Information Center, including 157 570 adult psychiatric inpatients in 19 specialized psychiatric hospitals from 2005 to 2018 in Beijing. Data on demographic characteristics and antipsychotic medication use were obtained from electronic health records. Schizophrenia, T2DM, and comorbidities were defined according to the International Classification of Diseases, 10th revision codes of discharge diagnosis. The overall prevalence of T2DM in adult psychiatric inpatients was calculated, and the annual prevalence of T2DM was calculated and adjusted to the overall participant population. Univariate and multivariate logistic regression analyses were performed to obtain crude ORs and adjusted ORs (aORs) on the risk of T2DM in patients with different demographic characteristics, schizophrenia, antipsychotic medication use, and different comorbidities. Age-specific prevalence of T2DM under a stratification of schizophrenia or other psychiatric disorders was calculated in the subgroup analysis. RESULTS Out of 157 570 adult inpatients, 16 939 had T2DM, with a prevalence of 10.75% (95% CI 10.60% to 10.90%). The prevalence was 11.63% (95% CI 11.37% to 11.88%) among patients with schizophrenia and 10.17% (95% CI 9.98% to 10.37%) among patients with other psychiatric disorders. During 2005-2018, the prevalence of T2DM in adult patients increased over the years, from an adjusted prevalence of 5.20% in 2005, to 10.98% in 2010, 12.50% in 2015, and 12.71% in 2018. Results from the multivariate analysis showed that increasing age, diagnosis of schizophrenia (aOR=1.23, 95% CI 1.18 to 1.29), and comorbidities of hypertension (aOR=3.09, 95% CI 2.97 to 3.22), lipid disorders (aOR=1.95, 95% CI 1.88 to 2.04), and fatty liver (aOR=1.93, 95% CI 1.84 to 2.03) were major risk factors of T2DM in adult psychiatric inpatients. CONCLUSIONS The prevalence of T2DM was high among adult psychiatric inpatients in Beijing, China. Elderly patients, those with schizophrenia, and those with hypertension, lipid disorders, and fatty liver had higher prevalence of T2DM. Prevention and treatment of T2DM are of utmost relevance in hospitalized psychiatric patients.
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Affiliation(s)
- Fude Yang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Qiuyue Ma
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Botao Ma
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Moning Guo
- Beijing Municipal Commission of Health and Family Planning Information Center, Beijing Municipal Commission of Health and Family Planning Policy Research Center, Beijing, China
| | - Fangchao Liu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Juan Li
- Beijing Geriatric Hospital, Beijing, China
| | - Zhiren Wang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
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Grøn AO, Dalsgaard EM, Ribe AR, Seidu S, Mora G, Cebrián-Cuenca AM, Charles M. Improving diabetes care among patients with severe mental illness: A systematic review of the effect of interventions. Prim Care Diabetes 2018; 12:289-304. [PMID: 29709403 DOI: 10.1016/j.pcd.2018.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIM Individuals with severe mental illness (SMI) who suffer from type 2 diabetes (T2DM) are likely to be sub-optimally treated for their physical condition. This study aimed to review the effect of interventions in this population. METHODS A systematic search in five databases was conducted in July 2017. RESULTS Seven studies on multi-faced interventions were included. These comprised nutrition and exercise counselling, behavioural modelling and increased disease awareness aiming to reduce HbA1c, fasting plasma glucose, body mass index and weight. CONCLUSION Non-pharmacologic interventions in individuals with SMI and T2DM could possibly improve measures of diabetes care, although with limited clinical impact.
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Affiliation(s)
- A O Grøn
- Section for General Medical Practice, Department of Public Health, Aarhus University, Denmark; Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.
| | - E-M Dalsgaard
- Section for General Medical Practice, Department of Public Health, Aarhus University, Denmark; Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
| | - A R Ribe
- Section for General Medical Practice, Department of Public Health, Aarhus University, Denmark; Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
| | - S Seidu
- Diabetes Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - G Mora
- Diabetes Research Centre, Leicester General Hospital, Leicester, United Kingdom; Los Alpes Primary Care Centre, Spanish National Health Service, Madrid, Spain
| | | | - M Charles
- Section for General Medical Practice, Department of Public Health, Aarhus University, Denmark; Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
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Ince SÇ, Günüşen NP, Özerdem A, Özışık S. Diabetes Self-Care Views of Individuals With Severe Mental Illness and Comorbid Type 2 Diabetes and of Those Only With Type 2 Diabetes. Arch Psychiatr Nurs 2017; 31:386-393. [PMID: 28693875 DOI: 10.1016/j.apnu.2017.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Sevecen Çelik Ince
- Faculty of Nursing, Psychiatric Nursing Department, Dokuz Eylul University, 35340 Izmir, Turkey.
| | - Neslihan Partlak Günüşen
- Faculty of Nursing, Psychiatric Nursing Department, Dokuz Eylul University, 35340 Izmir, Turkey.
| | - Ayşegül Özerdem
- Faculty of Medicine Internal Medicine, Department of Psychiatry, Dokuz Eylul University, 35340 Izmir, Turkey.
| | - Seçil Özışık
- Faculty of Medicine Department of Internal Diseases, Department of Endocrinology and Metabolism Diseases, Dokuz Eylul University, 35340 Izmir, Turkey.
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