An Overview of Diabetes Management in Schizophrenia Patients: Office Based Strategies for Primary Care Practitioners and Endocrinologists

Table 1

Special considerations for diabetes treatment in schizophrenia patients.

Prevention	Refer patient to structured program for weight management as lifestyle interventions are proven to work.
Screening	Perform screening frequently: every 3 months when staring antipsychotic, then every 6–12 months.; HbA1c is preferable to fasting blood sugar.
Medication switch	Confer with psychiatrist to change to medication with lower weight gain potential, if clinically feasible.
Patient education	Provide simplified recommendations as cognitive impairment may limit learning.; Schedule longer medical visits.
Treatment adherence	Arrange frequent follow-ups as compliance is often poor.; Communicate treatment plan to family and caregivers.
Diabetes care	Tailor frequency of glucose self-monitoring to patient capability.; Arrange home nursing services if available.; Address foot care at each visit as hygiene is often poor.; Treat wounds aggressively if skin breakdown is present.; Refer patient to dental care to prevent gingivitis.
Psychotropic side effects that mimic or exacerbate diabetes symptoms and complications	Psychotropic side effects include gastric slowing from anticholinergic agents,; sexual dysfunction from antipsychotics and antidepressants, and chronic kidney disease from lithium.
Pharmacologic treatment	Set flexible target HbA1c goals as hypoglycemia from tight glucose control may be difficult to self-manage.; Consider metformin early as proven efficacious in this population.; Prescribe basal or premixed insulin for easier management.
Surgical management	Refer patient to bariatric surgery if eligible by weight criteria.
Comorbid illnesses	Screen for and treat high prevalence conditions like tobacco dependence, obstructive sleep apnea, and hypertension.