This systematic review and meta-analysis aims to quantify potential disparities in type one and type two diabetes quality of care between individuals with mental disorders versus without mental disorders. People with mental disorders have an increased risk of diabetes for a variety of factors. The authors maintain there is conflicting evidence regarding the quality of diabetes care they receive and with this study the objective is to attempt to close this gap.
The authors searched Scopus, Embase, MEDLINE and PsycINFO for cohort and case controlled studies published between database inception and February 8, 2025 using the terms “mental disorder”, “diabetes”, and “quality of care”. Studies accepted were twofold: observational (cohort or case controlled) with 100+ participants to avoid bias and those measuring the monitoring and treatment of diabetes in people with versus without mental disorders (diagnosed by DSM or ICD standards).
A wide array of mental disorders were accepted in this study and include: schizophrenia, mood disorder spectrum, bipolar disorder, major depressive disorder, anxiety disorder, substance abuse disorder, dementia and 1 study with personality disorder. Data was collected from 49 studies, comprising 5,503,712 individuals of which 15.2% had a mental health disorder. Gender was included in 35 of the 49 studies of which 46% were female and 54% were male. Overall the mean age was 61.4 years. Data was collected between 19990-2020. Primary outcomes included any diabetes related monitoring and treatments including labs, HbA1c, Blood pressure, footcare, BMI, smoking status, retinal monitoring and diabetes education referral.
The authors found comprehensive quantitative evidence for disparities in diabetes care between people with versus without a mental health disorder. There were negative associations between mental health disorders and retinal exam, HbA1c testing, cholesterol management, foot exams and renal investigation. People with mental disorders were more likely to be prescribed insulin and less likely to be prescribed a GLP-1 receptor agonist and this held regardless of the mental health disorder under evaluation.
There were also lower odds of hypertension medication prescriptions and referral to diabetes education. The reader is referred to review the article for further associations between race, gender, individual countries and each specific mental health disorder as well as study limitations. The first three study limitations include lack of study homogeneity, some small study sizes and multiple country inclusion.
These results should contribute to best practices in evidence-based monitoring and treatment guidelines for people with diabetes and mental health disorders; however, the authors note more studies are needed.
Wagner E, Højlund M, Fiedorowicz JG, et al., Disparities in Diabetes Treatment and Monitoring for People With and Without Mental Disorders – A Systematic Review and Meta Analysis. The Lancet. (2026). 13:2, P112-124.