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Diabetes in a high secure hospital
I A MacFarlane1, G V Gill, D Finnegan
1Department of Diabetes and Endocrinology, University Hospital Aintree, Liverpool, UK. ian.macfarlane@aht.nwest.nhs.uk
Postgraduate Medical Journal
|February 5, 2004
Summary
Type 2 diabetes is common in secure hospitals, affecting 8.6% of patients. While control is often suboptimal, multidisciplinary care helps maintain stability, though lifestyle factors require further attention.
Area of Science:
- Endocrinology
- Psychiatry
- Public Health
Background:
- Diabetes mellitus is a significant public health concern, particularly in vulnerable populations.
- Secure hospital settings present unique challenges for managing chronic conditions like diabetes.
- Understanding the prevalence and contributing factors of diabetes in these environments is crucial for effective intervention.
Purpose of the Study:
- To determine the prevalence of diabetes mellitus in a high-security hospital.
- To identify potential causes and contributing factors to diabetes in this patient population.
- To assess the current control of diabetes and its management within the hospital setting.
Main Methods:
- A cross-sectional survey of 408 patients admitted under the Mental Health Act.
- A prospective cohort study of 22 patients with known diabetes, followed for 24 months.
- Evaluation of drug treatment, microvascular/macrovascular complications, glycated hemoglobin, and body mass index.
Main Results:
- The prevalence of known diabetes was 8.6% (35/408 patients), all with type 2 diabetes.
- Obesity, smoking, schizophrenia, and antipsychotic drug use were frequent; weight gain was common post-admission.
- Glycemic control was variable, with most patients above treatment targets, but remained stable over follow-up.
Conclusions:
- Type 2 diabetes is prevalent in this secure hospital population.
- Sedentary lifestyle, diet, smoking, and antipsychotic use likely contribute to diabetes prevalence and suboptimal control.
- Multidisciplinary input facilitated stable glycemic control, comparable to community clinics, but lifestyle modifications are needed to further reduce impact.