Metabolic Syndrome and Type 2 Diabetes

America is having an epidemic of diabetes according to the New England Journal of Medicine. Unfortunately, the risk is greater for people living with mental illness, especially those taking second-generation atypical antipsychotic medications (SGAs). Another issue to be aware of is metabolic syndrome, a condition that can be a precursor to diabetes.

Research has shown that individuals who live with mental illness still have a lot to learn about these conditions, and educational efforts can improve knowledge and action. That both conditions can be prevented, treated and sometimes reversed in many people is good news. Left untreated, these two issues can cause severe health problems and can shorten lives. NAMI Hearts & Minds can give you a start on the information you need to meet these problems head-on.

High Risk Individuals and Factors

Diabetes and metabolic syndrome are found in higher numbers in these groups of individuals living with mental illness:

• People living with schizophrenia and bipolar disorder/mood disorders. There is evidence of a genetic risk that is greater than the general population.
• African Americans, Latinos, Native Americans and Asian Americans.
• People who smoke. Smokers tend to be unable to manage their diabetes as well as nonsmokers and may have more diabetes-related complications. Quitting smoking can reduce your risk of being diagnosed with both conditions.
• People with a family history of diabetes and metabolic syndrome. Know your family history so you can make choices that are well-informed, including choices about what medicines you may take, what screenings and blood tests to monitor and how to make choices to reduce your risk.
• People who take second-generation atypical antipsychotic medication (SGAs). SGAs are now well-known to have increased risks for weight gain, diabetes and metabolic syndrome.

Metabolic Syndrome

Metabolic syndrome is a combination of medical risk issues. These issues include worsening sugar control, high blood pressure, elevated cholesterol and other problems. Metabolic syndrome raises the risk for diabetes and heart disease and can be thought of as a condition that precedes diabetes.

Waist circumference is a key measure for metabolic syndrome. To stay safe, it is recommended that waist circumference not exceed 40 inches in men and 35 inches in women.

There is evidence that this is a real issue for people living with mental illness-the syndrome equally affects both men and in women, and is more common in people who take SGAs. The same strategies you would consider in managing diabetes are the same you should consider if you have indications of metabolic syndrome-walking (and other exercise), nutrition and working with your health care provider to monitor your progress on this issue are the keys to its prevention.

Type 2 Diabetes

Diabetes is a problem related to how your body uses sugar. It is a serious medical problem. There are several types of diabetes, but we will focus on the adult-onset type, also called Type 2 diabetes.

Treatment and Disease Management

If you have Type 2 diabetes, making exercise, such as walking, and a healthy diet part of your lifestyle are good first steps to treating your condition.

There is no question that attention to exercise and diet is essential to managing and preventing these problems. In addition, there is increased interest in the use of antidiabetic medications such as metformin along with SGAs even before diabetes is identified.

This interest began in children in adolescents who are particularly sensitive to these side effects. In a trial of adults, randomized to metformin plus lifestyle versus lifestyle alone, the former group fared better in weight control. Active research is ongoing to study this question further, so ask your health care provider about the latest thinking on this subject.

The Food and Drug Administration issued a warning to doctors in 2003 about the risk of high glucose levels and SGAs. This has been well-described in research literature, but the January 2010 issue of the Archives of General Psychiatry, one of the JAMA/Archives journals, reports that doctors are not monitoring their patients adequately.

If you have diabetes, ask your health care provider to get a longer-term measure of your sugar control, called an HgbA1c (pronounced hemoglobin A one C). This can tell you how your diabetes has been controlled over the previous months and is a good way to get information about your current condition. This can help to inform your future efforts. In general, a reading of seven or lower is considered good.

Self Advocacy

A very troubling fact is that most people living with mental illness and metabolic syndrome or Type 2 diabetes are not getting good preventive or medical care. A large study demonstrated that many people who live with schizophrenia are not getting the necessary care to look at their metabolic, diabetic and overall cardiac risks. Even though they are trained as medical doctors, sometimes psychiatrists don't consider medical problems to be a core aspect of their responsibility. Conversely, some internists manage diabetes everyday but do not appreciate the increased risk of people living with mental illness or the risks associated with the use of SGAs. People can find themselves between the two systems with a lack of clarity about roles and responsibilities, resulting in fragmented care. This culture problem may be improving: Medical homes and integration efforts are growing, but it is not likely to change quickly. We have a long way to go before excellent medical care for NAMI members is routine.

Learn more about becoming your own medical self advocate by exploring the Medical Self Advocacy section of the NAMI Hearts & Minds Web site.

Weight Maintenance

A combination of exercise and nutrition can make a great difference in managing weight. As a result, there are many efforts springing up around the nation as the mental health peer movement and culture approaches this issue.

Check your local clubhouse, NAMI Walks or community mental health program -- you may find a walking group, a nutritional and fitness group or a peer support program. There is not one easy answer to these issues; the key is to find what supports and actions are right for you. Below are some tools that might be helpful for you. The use of Web sites like these should be done with the support and collaboration of your doctor.

Work with your health care provider to discuss what to watch-typically your weight and your triglycerides. These are the first areas of concern that will emerge for people who take SGAs. High blood pressure and high cholesterol usually show up later on as problems that may require attention.

Visit the NAMI Hearts & Minds resources section for references.