Endocrine Abstracts

Background: Managing mental health patients with Diabetes Mellitus can be challenging. Patients with mental health problems are poorly compliant with both antipsychotic and diabetes treatment. Literature has suggested that some psychiatric illnesses can be independent risk factors for diabetes. Furthermore, diabetic patients have a higher incidence of psychiatric disorders. There is a causal relationship between newer antipsychotic medications and metabolic abnormalities.

Cases from two hospitals: 1. 72 year old lady was admitted after being found on the floor in the psychiatric unit. On admission, her glucose was 56 mmol/l with ketonuria. She was treated as Diabetic Keto-Acidosis (DKA). She was on olanzapine.

2. 43 year old lady was admitted with glucose of 38 mmol/L. Her HbA1C was 160 mmol/mol. She was treated as hyperosmolar hyperglycaemic state (HHS). She was on amisulpride.

3. 38 year old lady admitted with increased confusion, her glucose was 76mmol/L. Complicated by an acute kidney injury, sepsis and acidosis; she was treated as DKA. She was on olanzapine

4. 36 year old lady was admitted after general decline in health. She had a glucose of 73.3 mmol/L and was acidotic. She was treated as DKA. She was on olanzpine and amisulpiride.

Discussion: Olanzapine, clozapine and amisulpride are known as novel antipsychotics. The British National Formulary states diabetes and hyperglycaemia are side effects of antipsychotics. Olanzapine and clozapine have the highest propensity to induce hyperglycaemia. The time taken for clinical manifestations of hyperglycaemia varies from days to years. Poor compliance leads to recurrent hospital admission especially in patients with both conditions. The recent introduction of Abbot’s Freestyle Libre has transformed glucose monitoring. Its simplicity may play a vital role in patients with psychiatric disorders. The use of insulin pumps in patients with mental health remains debatable.

Conclusion: • Patients on antipsychotics should be monitored for hyperglycaemia.

• We recommend if one is commencing an antipsychotic in a patient then the assessment for diabetes should take place at initiation, at 3–4 months and annually.

• Physicians must be made aware of the growing association between atypical antipsychotics, diabetes and hyperglycaemic crises.

• Managing diabetes in patients with psychiatric disorders requires an integrated multidisciplinary approach involving both primary and secondary care teams.

• We suggest that clinicians encourage the use of technology such as flash glucose monitoring together with support from family or carers to improve compliance and diabetes care in this special group of patients.