Pharmacists Often Miss Critical Opportunities to Counsel Mentally Ill Diabetics

Pharmacists and other health care providers often do not advise patients with mental illness symptoms and diabetes to make lifestyle changes that would reduce related health risks.

For their research published in The Diabetes Educator, a trio of investigators from the University of Illinois studied nearly 6000 adults aged 18 to 70 years with serious psychological distress (SPD) and comorbid diabetes or diabetes risk factors. The authors examined the lifetime prevalence and correlates of health care providers’ advice to increase exercise and reduce dietary fat intake across this patient population.

“We know that lifestyle behaviors account for much of the illness and suffering associated with chronic diseases,” said lead study author Xiaoling Xiang, MPhil, in an email to Pharmacy Times. “Research has shown that the rates of unhealthy lifestyle behaviors are higher among patients with mental illness. Therefore, it is important to target patients with mental illness to receive lifestyle counseling.”

Among those studied with SPD symptoms, the prevalence of comorbid diabetes was about 15%, compared with about 8% among their peers. Additionally, almost three-quarters of those with mental illness had body mass indexes >25, compared with 64% of their peers. The SPD patients also had significantly higher rates of hypertension, hyperlipidemia, and cardiovascular disease.

Nevertheless, more than half of those with SPD—and nearly two-thirds of those with comorbid diabetes—had never been advised by a health care provider to increase exercise or reduce dietary fat intake.

“The results suggest that patients with mental illness are not adequately advised to increase exercise or adopt a healthier diet,” Xiang told Pharmacy Times. “The rates of provider advice were particularly low for patients with mental illness alone.”

However, the likelihood of an SPD patient receiving advice on lifestyle changes from a health care provider increased as the number of his or her diabetes risk factors increased, and it was highest among those with comorbid diabetes.

Xiang noted that pharmacists could play a critical role in boosting the rates of lifestyle counseling, given that many patients with severe mental illness are chronic users of antipsychotics, which can cause dramatic weight gain, dyslipidemia, and metabolic abnormalities.

“Pharmacists are well positioned to educate patients about the side effects of these medications, provide brief health advice, and refer them to resources in the community to mitigate the side effects,” Xiang told Pharmacy Times. “Pharmacists can also collaborate with other health care providers, such as mental health professional, physicians, dietitians, and exercise specialists, to establish a formal referral system in order to encourage and reinforce patients’ engagement in healthy lifestyles.”