Pharmacological management of diabetes in severe mental illness: a comprehensive clinical review of efficacy, safety and tolerability

TY - JOUR

T1 - Pharmacological management of diabetes in severe mental illness

T2 - a comprehensive clinical review of efficacy, safety and tolerability

AU - Lally, John

AU - O’ Loughlin, Aonghus

AU - Stubbs, Brendon

AU - Guerandel, Allys

AU - O’Shea, Donal

AU - Gaughran, Fiona

PY - 2018/3/9

Y1 - 2018/3/9

N2 - INTRODUCTION: The increased prevalence of Type 2 diabetes mellitus (T2DM) in severe mental illness (SMI) contributes to increased cardiovascular morbidity and reduced life expectancy for people with SMI. Areas covered: In the present clinical review, we summarize the efficacy, safety and tolerability of selected diabetic pharmacotherapy options in SMI and discuss the quality and strength of evidence. Expert commentary: General principles for treating T2DM in SMI involve identifying treatments which promote weight loss and which have low or no risk of hypoglycemia. Patient engagement in decision making about treatment choices is an important factor to ensure adherence and successful use of the chosen therapy. The first line therapeutic option for T2DM in SMI for which there is most evidence is metformin. Based on general population data, second line treatment options in combination with metformin to achieve glycated haemoglobin treatment goals include GLP-1R agonists, DPP-4 inhibitors, sulphonylureas, SGLT2 inhibitors, pioglitazone and insulin, with most evidence for the use of GLP-1R agonists in SMI. Alongside efficacy and tolerability, treatment for T2DM in SMI should be considered on a patient-tailored basis.

AB - INTRODUCTION: The increased prevalence of Type 2 diabetes mellitus (T2DM) in severe mental illness (SMI) contributes to increased cardiovascular morbidity and reduced life expectancy for people with SMI. Areas covered: In the present clinical review, we summarize the efficacy, safety and tolerability of selected diabetic pharmacotherapy options in SMI and discuss the quality and strength of evidence. Expert commentary: General principles for treating T2DM in SMI involve identifying treatments which promote weight loss and which have low or no risk of hypoglycemia. Patient engagement in decision making about treatment choices is an important factor to ensure adherence and successful use of the chosen therapy. The first line therapeutic option for T2DM in SMI for which there is most evidence is metformin. Based on general population data, second line treatment options in combination with metformin to achieve glycated haemoglobin treatment goals include GLP-1R agonists, DPP-4 inhibitors, sulphonylureas, SGLT2 inhibitors, pioglitazone and insulin, with most evidence for the use of GLP-1R agonists in SMI. Alongside efficacy and tolerability, treatment for T2DM in SMI should be considered on a patient-tailored basis.

KW - Decision Making

KW - Diabetes Mellitus, Type 2/drug therapy

KW - Hypoglycemic Agents/administration & dosage

KW - Medication Adherence

KW - Mental Disorders/physiopathology

KW - Severity of Illness Index

KW - Weight Loss/drug effects

U2 - 10.1080/17512433.2018.1445968

DO - 10.1080/17512433.2018.1445968

M3 - Review article

C2 - 29480037

SN - 1751-2433

VL - 11

SP - 411

EP - 424

JO - Expert review of clinical pharmacology

JF - Expert review of clinical pharmacology

IS - 4

ER -