People with type 2 diabetes who also have a severe mental illness (SMI) tend to start diabetes medicines earlier than other patients, according to a large study from Scotland.
Earlier Use of Metformin and Insulin
Researchers reviewed records from more than 317,000 adults diagnosed with type 2 diabetes between 2004 and 2022. Among them, 14,600 had an SMI such as schizophrenia, bipolar disorder, or major depression.
Patients with an SMI were more likely to begin treatment sooner.
Two years after diagnosis: 55.7% of patients with SMI had started metformin, compared with 49.7% of those without SMI.
Ten years after diagnosis: 13.3% of patients with SMI had started insulin, compared with 9.1% without SMI.
Differences by Mental Health Condition
People with bipolar disorder or major depression had higher rates of both metformin and insulin use than patients without SMI.
For people with schizophrenia, metformin use was similar to others, but insulin use was lower.
What the Results Suggest
After accounting for age, sex, smoking status, blood sugar levels, and other factors, patients with SMI were still more likely to start treatment earlier. The study team said better coordination between mental health and physical healthcare is needed to help these patients manage diabetes and avoid complications.
Because SMI was identified through hospital records, some milder cases may not have been captured. And as an observational study, it cannot prove that mental illness directly leads to earlier treatment.
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