Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART)

For many people living with schizophrenia and related disorders, often in their early twenties, starting antipsychotic medication is a vital step toward stability and recovery. While these medications are effective in reducing symptoms of psychosis, they can also cause rapid weight gain by disrupting blood sugar regulation, reducing fullness signals, and increasing cravings for high-calorie foods. This weight gain significantly raises the risk of type 2 diabetes, cardiovascular disease, and can also negatively effect self-esteem and social engagement. In some cases, these weight-inducing side-effects can even lead to individuals discontinuing their medication, resulting in relapse and hospitalisation.

That’s why we created SMART, in collaboration with individuals who have lived experience of these challenges, as well as with professionals from a wide range of disciplines such as psychiatry, endocrinology, nutrition, and e-health science

What is SMART?

SMART is an SMS-based support system designed with and for people on antipsychotic medication, starting from day one. It delivers interactive, personalised text messages that guide users through small, achievable steps toward healthier living. The goal is to build confidence and skills to manage health, and specifically metabolic health such as blood sugar levels and weight, more effectively.

Each message is grounded in evidence-based behaviour change techniques and best-practice diabetes prevention and management care. The content offers motivational support across key areas, including physical activity, nutrition, weight management, and stress reduction. Users can also opt in to receive messages on monitoring blood sugar levels and ceasing smoking or vaping. Additionally, they can tailor the messages to fit their personal priorities and preferred times for receiving them.

SMART empowers users with the tools, knowledge, and confidence to take charge of their metabolic health. Early findings from a pilot study show promising outcomes, including improvements in diabetes self-management, health literacy, social functioning, and overall “patient activation,” which reflects a person’s confidence and ability to manage their own health and health care.

Why SMART Matters

SMART is built on the principles of accessibility, agency, and equity. It aims to support people living with schizophrenia, who are disproportionately affected by antipsychotic-related metabolic risks, by offering practical, low-tech personalised ways to improve their physical health, including diabetes self-management, and to reduce the risk of developing chronic conditions like diabetes. Ultimately, SMART helps bridge the gap between mental health treatment and physical health care, promoting a more holistic treatment approach that can lead to longer and healthier lives.

What’s Next?

We’re now seeking funding to launch a full-scale randomised controlled trial to rigorously test SMART’s impact on health outcomes and potential healthcare cost savings. We are particularly focused on expanding SMART’s reach to regional and remote communities across Australia, where health disparities are more pronounced and access to mental health support is often limited.

We believe people living with schizophrenia deserve early, effective support in managing their physical health before complications escalate and place added strain on individuals, families, and healthcare systems.

To learn more or get involved, contact Dr Urska Arnautovska at This email address is being protected from spambots. You need JavaScript enabled to view it..

Publications

A Novel Digital Intervention to Facilitate Diabetes Self-Management Among People with Schizophrenia and Related Disorders: Development and Acceptability Testing of SMART

Media

A SMART change for people living with schizophrenia and diabetes

Project Team