Background: People with severe mental illness (SMI), i.e., psychotic and major affective disorders, face twice the risk for developing type 2 diabetes. Antipsychotic medication treatment contributes to elevated risk through weight gain and other metabolic side effects. Although clinical trial evidence supports both lifestyle and pharmacological approaches to mitigate medication-induced weight gain and diabetes risk in SMI, research on patient preferences is lacking.

Methods: We conducted semi-structured interviews with adults who had SMI, were on antipsychotic medications, had no diagnosed diabetes, and were receiving psychiatric care in a large nonprofit health care system.

Results: A total of 36 individuals participated (72% women; ages 19-63 years; 42% non-White; 17% Medicaid). They were prescribed quetiapine (53%), olanzapine (31%), or risperidone or iloperidone (17%). Metabolic risk factors were common (obesity 67%, prediabetes 28%); 64% rated physical health as poor to fair; 89% cited excess weight or weight gain as a major health concern. Most (86%) reported past efforts at lifestyle modification to manage weight, with a third pursuing related health services (nutrition counseling, health classes). Barriers to lifestyle modification included time constraints, fluctuating motivation, and excess costs. We found low patient awareness of pharmacological strategies to manage diabetes risk (e.g., metformin), despite the majority of participants describing interest in this option. Participants perceived a role for both psychiatrists and primary care physicians in helping them manage diabetes risks.

Conclusions: Patients with SMI are receptive to multiple evidence-based diabetes prevention strategies that span primary care and specialty mental health care domains, including both medication and motivational supports, available at low cost and at convenient times.


E. Iturralde: None. A.L. Jones: None. N. Slama: None. A.H. Kline-Simon: None. S. Sterling: None. J. Schmittdiel: None.


National Institute of Diabetes and Digestive and Kidney Diseases; Health Delivery Systems- Center for Diabetes Translational Research (NIDDK HDS-CDTR)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at