Diabetes self-management in people with severe mental illness

Diabetes is a common and a serious global health problem, currently affecting an estimated 8.3% of adults - 382 million people worldwide, and taking up 11% of international health expenditure (International Diabetes Federation, 2013). Type 2 diabetes is the commonest type of diabetes and accounts for around 90% of cases. This condition typically develops during adulthood, usually in people over the age of 40 years, but younger onset is becoming increasingly more common. The disease is characterised by poorly regulated blood glucose levels, which may arise from defects in insulin secretion (insulin deficiency), or in its action (insulin resistance), or both. Therefore, the aim of treatment is to manage blood glucose levels to alleviate short-term symptoms and prevent or delay the development of long-term complications. Raised glucose in the blood, known as hyperglycaemia can initially be controlled by lifestyle management such as changes to diet and exercise, but given the progressive nature of type 2 diabetes it is likely that most individuals will ultimately require pharmacological intervention as well. This may initially be with oral hypoglycaemic drugs to increase the production or uptake of insulin and, if the disease remains uncontrolled, insulin therap