Joint British Diabetes Societies for inpatient Care (JBDS-IP): Guidelines for the management of diabetes in adults with psychiatric disorders in inpatient settings
Introduction: Diabetes is highly prevalent among individuals with mental disorders, with rates more than double that of the general population.1 These individuals face significant barriers to effective diabetes management, including antipsychotic-induced metabolic risks, lifestyle factors, cognitive...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001459 |
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| Summary: | Introduction: Diabetes is highly prevalent among individuals with mental disorders, with rates more than double that of the general population.1 These individuals face significant barriers to effective diabetes management, including antipsychotic-induced metabolic risks, lifestyle factors, cognitive impairment and fragmented care between mental health and diabetes services. As a result, people with mental disorders experience poorer glycaemic control, higher rates of diabetes complications and increased hospital admissions, contributing to a 15–20-year reduction in life expectancy.2,3Managing diabetes in hospitalised patients with mental disorders pres,ents unique challenges in both acute and chronic settings. In emergency situations, such as diabetic ketoacidosis (DKA), treatment is often delayed because of concerns about mental capacity, refusal of care or hesitancy to override patient autonomy. The new guidelines emphasise the importance of prompt treatment in acute emergencies, with early application of the Mental Capacity Act (MCA) when necessary, ensuring that treatment is not delayed while still considering least restrictive options whenever possible.4,5In chronic scenarios, the guidelines stress the importance of structured diabetes screening, tailored interventions and improved communication between mental health and diabetes teams to prevent deterioration and avoid unnecessary hospitalisation.6 Additionally, cardiovascular risk reduction strategies are incorporated, including lipid management, blood pressure control and glycaemic targets, ensuring a comprehensive approach to diabetes care in this high-risk population.7 Methods: The updated guidelines incorporate national and international best practices, expert consensus and case-based analyses to formulate a structured approach for the management of acute and chronic diabetes care in hospitalised patients with mental disorders. We designed a flow diagram to support decision-making in acute scenarios, ensuring timely intervention while balancing patient autonomy and duty of care.8 Results and Discussion: 1. Acute management of diabetes in people with mental disorders: ○ The framework prioritises urgent recognition and treatment of diabetic emergencies in patients with mental disorders, ensuring early mental capacity assessment and minimising treatment delays; ○ Best-interest decision-making processes are outlined for cases of impaired capacity, with a focus on using the least restrictive options where possible; ○ Collaboration between psychiatry, diabetology, and acute medicine is crucial in managing diabetes-related crises.2. Chronic diabetes care and risk reduction: ○ Guidelines provide structured diabetes screening and monitoring recommendations tailored for individuals with mental disorders; ○ Cardiovascular risk management recommendations focus on lipid-lowering therapy, blood pressure control, and glycaemic targets to mitigate long-term complications.3. Decision-making and the Mental Capacity Act: ○ The framework incorporates a stepwise approach to mental capacity assessment in diabetes care; ○ Practical guidance is provided for balancing patient autonomy and the necessity of urgent medical intervention; ○ The guidelines encourage a multidisciplinary approach, ensuring psychiatric teams are involved in discussions about long-term diabetes management. Conclusion: This updated JBDS-IP guideline provides a structured approach for managing diabetes in hospitalised patients with mental disorders (Fig 1). By integrating diabetes care with mental health treatment, the framework aims to reduce morbidity, improve treatment adherence and optimise patient outcomes. The implementation of an evidence-based guidance enhances clinical decision-making, ensuring prompt intervention while respecting patient autonomy. |
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| ISSN: | 1470-2118 |