Prescribing of glucose‐lowering medication to adults with type 2 diabetes by severe mental illness status in Scotland: A cohort study
Authors' conclusion
Among people with type 2 diabetes each of metformin and insulin is prescribed sooner in people with compared to those without SMI. Further research is needed to understand the reasons for this, and to investigate the implications of these differences in prescribing patterns.
Study context
- Population
- People in Scotland diagnosed with T2D between January 2004 and March 20224.6% with pre-existing severe mental illness (SMI)
- Participants
- 317,761 people
- Exposure
- SMI vs no SMI
- SMIn = 14,600
- Outcome
- Time from diabetes diagnosis to first prescription of metformin and of insulin
- Follow-up
- Median 1.6 years
Methodological detailsroutinely collected linked data, Cox proportional hazards models, adjusted for age, sex, area-based socio-economic deprivation, smoking status, baseline HbA1c and eGFR
- Routinely collected linked data
- Cox proportional hazards models
- Adjusted for age, sex, area-based socio-economic deprivation, smoking status, baseline HbA1c and eGFR
Main finding
As reported in the abstract
Time to first metformin and insulin prescription
SMI vs Without SMIHazard ratio (95% CI)
First metformin prescription; adjusted
1.09(1.07–1.11)
First insulin prescription; adjusted
1.24(1.18–1.31)
Observational data: associations, not effects.
Further findings
Prescribed metformin · median follow-up 1.6 years
Sensitivity analysis additionally adjusted for body mass index (BMI) (BMI missing in 21%)
- Similar estimates when additionally adjusted for BMI in people with BMI data
Original publication
Prescribing of glucose‐lowering medication to adults with type 2 diabetes by severe mental illness status in Scotland: A cohort study. Diabetes Obes Metab. Published 14 November 2025. doi:10.
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