Determinants of and barriers to diabetes care among patients with serious mental illness: A scoping review with recommendations

Aim: We performed a scoping review to identify the diabetes care determinants and barriers in patients with serious mental illness (SMI), in view of limited evidence and clarity. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines. PubMed, EMBASE, and Scopus were searched from inception to September 2023 to identify eligible studies. Observational studies that reported the determinants of and barriers to diabetes care among SMI patients were considered. A narrative synthesis of review results was performed to gather evidence. Recommendations were framed in the context of this evidence. Results: Of the 8727 non-duplicate records, only 10 studies that met the inclusion criteria were considered for this review. Of these, four were cohort, two were case-control, and four were cross-sectional in design. All 10 studies were observed to have robust methodologies. Diabetes measures examined in these studies included not only the Healthcare Effectiveness Data and Information Set (HEDIS) measures (HbA1c, retinopathy, nephropathy, and blood pressure), but also lipid, foot, and BMI. Factors contributing to inadequate diabetes care can be attributed to the healthcare system, healthcare providers, and at the patient-level. Conclusion: Currently, there is lack of evidence on determinants of quality diabetes care among SMI patients. Further, adequately powered long term follow-up studies are needed to understand the impact of diabetes care on their clinical outcomes.