Review: some evidence that lifestyle education can help diabetics with schizophrenia

Fruit slices

For many different reasons, people with schizophrenia and schizoaffective disorders have a greater risk of type 2 diabetes.  This review looked for evidence of the efficacy of interventions to help them manage their diabetes.

Clinical question:

In people with type 2 diabetse and schizophrenia or schizo-affective disorder, what lifestyle interventions improve self-management?

The scope included education, diet and exercise interventions that addressed the challenges associated with schizophrenia, such as decreased cognitive ability, reduced motivation and limited access to resources.  The outcomes of interest were HbA1c, fasting blood glucose (FBG) and body mass index (BMI) or weight lost.

The evidence:

Four articles were identified for inclusion in the review.  Two of these were randomised trials, two were observational studies with no control group.  However, the reviewers considered the studies to be of good or excellent methodological quality.

The randomised trials of an out-patient education programme found that participants lost weight whilst the control group gained weight.  This difference was statistically significant.  Improvements in HbA1c were not statistically significant.

Appraisal hints:

  • The literature search not include EMBASE and may have missed relevant studies.
  • Selection criteria were defined in advance and applied by two independent reviewers.
  • There was considerable heterogeneity between the studies in terms of setting and interventions.
  • The randomised trial was conducted on self-selected volunteers, and may represent a sub-set of highly motivated patients when compared with the general population.
  • The trial populations were all “older adults” (mean age 44-53 years).
  • Details of the specific educational programmes are not provided in the review.
  • The impact of antipsychotic drugs needs to be taken into account when applying this evidence.  Would these findings translate to your patients or setting?


The full text of this review is available from the link below:

Cimo A, Stergiopoulos E, Cheng C, Bonato S, Dewa CS.  Effective lifestyle interventions to improve type II diabetes self-management for those with schizophrenia or schizoaffective disorder: a systematic review. BMC Psychiatry. 2012 Mar 23;12(1):24. [Epub ahead of print]

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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