The Fusion Clinic at Steno Diabetes Center Zealand (SDCS) is the first place in Denmark where people with diabetes and concurrent mental illness can access integrated treatment and support for both. Staff at the clinic take a person-centred, flexible, holistic approach to their patients, and surveys show that it’s working.
The Fusion Clinic first opened in February 2020 with the aim of improving treatment for people with concurrent diabetes and mental illness, a patient group that tends to experience more complications from their diabetes, a lower quality of life, and a shorter life expectancy than people with diabetes only. Many also have other conditions, some diagnosed, others not.
Treatment at the clinic is based on the FACT model (Flexible Assertive Community Treatment), a multidisciplinary model aimed at providing hands-on, integrated care. Staff include psychiatric and endocrinology nurses and doctors, as well as a dietician, a podiatrist and a social worker.
A survey carried out in 2023 showed that, after starting treatment at the clinic, the number of hospitalization days has dropped by 32% and there have been significant improvements in blood glucose levels among the patients. Interviews with patients also showed high satisfaction with the treatment provided. Patients mentioned the ease and advantage of having both conditions handled at the same time and the fact that they are listened to, rather than simply told what to do.
‘We are difficult to get rid of’
Key to the approach is an awareness that a person’s diabetes and their mental illness interact and impact each other, and that patients therefore benefit when the endocrinological and psychiatric experts work together and at a tempo that suits the person’s individual needs.
“The pace is very important,” said Monica Santos, the clinic’s psychiatrist, in an interview with Danish medical news site Ugeskrift for Læger. “We have to go at the patient’s pace, because if the patient is not ready to start any new medicine or change their diet, then it can’t happen now.”
Head of the Fusion Clinic, Mette Wallbohm Olsen, also highlights the impact of a severe mental illness on a patient’s ability to manage the combined effect of their mental and physical conditions.
“Things are connected,” she says. “If you feel so bad mentally that you are effectively unable to take care of your diabetes, then the worsening diabetic condition can contribute to further worsening of your mental illness. Conversely, we also know very well that some of the medicines we use in psychiatry can impact a person’s diabetes. So it just makes good sense to take care of both conditions together.”
In the periods when a patient is particularly struggling to manage the combined effect of their diabetes and their mental illness, the clinic’s staff keep an even closer eye on their conditions, even visiting their homes if they don’t show up for appointments.
“We are difficult for the patients to get rid of,” Wallbohm Olsen told Ugeskrift for Læger, “and we have to be. When our patients don’t show up, we know it’s a sign of illness, so we move closer.”
Holistic care
Often, the combination of a watchful eye and the collaboration between experts in psychiatry and diabetes has extremely effective results.
“We’ve seen examples of people with severe depression where we regulate their blood sugar, their vitamin deficiency and their metabolism, who come back three months later and ask to be released [from the Fusion Clinic], because they feel good and no longer see themselves as depressed,” said endocrinologist Sine Wanda Jørgensen to Ugeskrift for Læger.
The services the clinic provides go far beyond traditional treatment too. Once a week, staff can get input from a clinical pharmacologist to go through some patients’ lists of medication – often 10-20 different drugs – to see if and how it can be reduced or made simpler to accommodate the patient’s situation. In line with the FACT model, staff also sometimes drive out to patients’ homes to check how they’re doing.
Wallbohm Olsen sees huge potential for the same model to be replicated in other health areas: “We’ve specialized in diabetes, but what if we had done it in the heart or lung area? There are plenty of opportunities to create fusion clinics.”
Further information
Novo Nordisk Foundation, Judith Vonberg, Communications Specialist, +45 4172 7925, jvo@novo.dk