A digital intervention is set to change the way people living with schizophrenia prevent and manage type 2 diabetes (T2D).
Individuals diagnosed with schizophrenia spectrum disorders (SSD) are 3-5 times more likely to develop type 2 diabetes due to severe metabolic side effects of antipsychotic medications like rapid weight gain, along with lifestyle factors such as poor nutrition and inadequate physical activity.
Furthermore, many people with SSD struggle to advocate for their health needs and experience social and economic disadvantages in accessing appropriate care, resulting in delays to specialist care, increased health complications, and hospital admission rates.
In response to these complex health issues experienced by patients living with schizophrenia and diabetes, Dr Urska Arnautovska from UQ’s PA-Southside Clinical Unit, in collaboration with the Queensland Centre for Mental Health Research (QCMHR) and CSIRO, has led the development of the Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART).
“SMART is tailored for people with schizophrenia-related disorders and will enable them to actively protect their metabolic health by improving access to simple, early prevention and diabetes management strategies,” Dr Urska Arnautovska explains.
“It is an SMS-based support system that was created by a highly multidisciplinary, international team, and co-designed with people with lived experience.
“Users receive interactive, personalised text messages that help them take small, manageable steps towards making healthier lifestyle choices, leading to greater confidence in managing their health, and ultimately, to better health.
“Each message is grounded in evidence-based behaviour change techniques and diabetes care, and offers motivational support around core areas like physical activity, nutrition, weight management, and coping with stress.
“Users can choose what’s most important to them and when they’d like to receive messages.”
SMART has been designed to give users the skills, knowledge and confidence to take ownership of their metabolic health.
Preliminary results from a study of SMART users have shown significant improvements in diabetes self-management, health literacy, social functioning, and overall confidence to manage their health—what’s known as “patient activation”.
Dr Arnautovska said the concept of patient activation is crucial to the success of SMART because it is one of the strongest predictors of health outcomes—especially for chronic diseases like diabetes.
“It’s especially powerful for people who’ve often been excluded or overlooked – like those living with complex mental health challenges and comorbidities,” Dr Arnautovska explains.
“SMART is about accessibility, agency and equity – we want to empower people living with schizophrenia – who as the result of antipsychotics’ side-effects are faced with this additional burden, that is high risk of developing diabetes - to better protect and manage their metabolic health and in turn, experience better health outcomes and longer lives.”
The team is looking for funding to support a full-scale randomised controlled trial which could test the effectiveness of SMART on various health outcomes, as well as potential cost savings in healthcare service use.
They’re particularly interested in offering SMART to regional and remote communities across Australia where health disparities are even greater, and where people living with complex mental health problems typically receive even less support.
The SMART Research Team believes that people living with schizophrenia deserve to be upskilled and supported with practical ways of protecting their metabolic health early on, before the complications of mental and physical health start to snowball and cause negative impacts to themselves, their families, and also to clinical care and health systems. If you’d like to learn more or get involved with SMART, contact Dr Urska Arnautovska at u.arnautovska@uq.edu.au.
