The Fusion Clinic: Integrating the care of people with severe mental illness and diabetes

Abstract

Aim: People with coexisting severe mental illness (SMI) and type 2 diabetes have a shorter life expectancy and poorer diabetes outcomes than those without SMI. This is partly explained by the separate treatment of diabetes and SMI, which occurs in parallel silos in many healthcare systems. The Steno Diabetes Center Sjaelland and Region Zealand established the Fusion Clinic to offer combined psychiatric and diabetes care delivered by both diabetes and mental healthcare professionals. This study describes how the clinic was established and the initial diabetes outcomes.

Methods: The Fusion Clinic was co-designed by people with diabetes and SMI and healthcare professionals to improve the care of adults with diabetes and SMI. The clinic approach utilised the F-ACT model. The 63 people referred to the Fusion Clinic between 01.02.2020 and 01.01.2022 who attended the clinic for more than 6 months were included in this study. Diabetes outcomes were recorded in the electronic medical records (Sundhedsplatformen EPIC).

Results: There was a high prevalence of diabetes complications at baseline. Furthermore, 70% had one or more additional concomitant diseases, as well as SMI and diabetes. Assessment of diabetes complications and measurements of HbA_1c and lipid profile improved after referral to the clinic. HbA_1c declined during the first 6 months of attendance at the clinic.

Conclusions: This model of service delivery has the potential to improve the quality of care for people with SMI and type 2 diabetes.

Keywords: combined care clinics; diabetes; psychiatric disorders; severe mental illness; type 1 diabetes; type 2 diabetes.