PEOPLE living with mental disorders face a substantially higher risk of diabetes, yet new evidence shows they are less likely to receive recommended diabetes monitoring and modern treatments. A large systematic review and meta-analysis highlights persistent disparities in diabetes care quality that may contribute to excess morbidity and mortality in this population.
Examining Diabetes Care in People with Mental Disorders
Cardiometabolic disease is a major driver of premature mortality among people with mental disorders. This new analysis aimed to clarify whether people with mental disorders receive the same standard of diabetes care as those without psychiatric diagnoses.
Researchers systematically reviewed cohort and case-control studies comparing diabetes monitoring and treatment indicators in individuals with and without mental disorders. The primary focus was whether patients received any recommended diabetes monitoring or treatment, using a composite of nine established clinical indicators.
Large-Scale Evidence Reveals Consistent Disparities
The meta-analysis included 49 studies encompassing more than 5.5 million people with diabetes, of whom over 838,000 had a diagnosed mental disorder. Across studies spanning Asia, Europe, North America, and Australasia, individuals with mental disorders were significantly less likely to receive recommended diabetes monitoring overall.
Lower odds were observed for HbA1c testing, retinal screening, lipid and cholesterol measurement, renal investigations, and foot examinations. These gaps were evident across multiple diagnostic groups, including mood disorders, major depressive disorder, schizophrenia, bipolar disorder, and substance use disorders. Treatment disparities were also identified. People with mental disorders were more likely to be prescribed insulin but substantially less likely to receive GLP-1 receptor agonists, suggesting unequal access to newer diabetes therapies. The analysis found no evidence that these findings were driven by publication bias.
Implications for Health Systems and Clinical Practice
These results provide the strongest quantitative evidence to date that mental disorders are associated with systematically poorer diabetes care. Inadequate monitoring and reduced access to modern therapies may help explain the higher cardiometabolic mortality observed in this population. The findings highlight the need for better integration between mental health services, primary care, and diabetes management.
Reference
Wagner E et al. Disparities in diabetes treatment and monitoring for people with and without mental disorders: a systematic review and meta-analysis. The Lancet Psychiatry. 2026;doi:10.1016/S2215-0366(25)00332-3.
