<p class="first" id="d6327045e229">Close to 19 million US adults have severe mental
illnesses (SMI), and they die, on
average, 25 years earlier than the general population, most often from cardiovascular
disease (CVD). Many of the antipsychotic medications used to treat SMI contribute
to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension.
Based on compelling evidence, the American Diabetes Association and the American Psychiatric
Association developed guidelines for metabolic screening and monitoring during use
of these medications.
</p><p id="d6327045e231">In this manuscript, we have reviewed the evidence on diabetes
and other CVD risk screening,
prevalence, and management among populations with SMI. We also review differences
in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women,
and children). We found that despite national guidelines for screening for diabetes
and other cardiovascular risk factors, up to 70 % of people taking antipsychotics
remain unscreened and untreated. Based on estimates that 20 % of the 19 million US
adults with SMI have diabetes and 70 % of them are not screened; it is likely that
over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed
diabetes costs over $4,000 per person, this failure to identify diabetes among people
with SMI represents a missed opportunity to prevent morbidity and translates to over
$8 billion in annual preventable costs to our healthcare system.
</p><p id="d6327045e233">Given the high burden of disease and significant evidence
of suboptimal medical care
received by people with SMI, we propose several clinical and policy recommendations
to improve diabetes and other CVD risk screening and care for this highly vulnerable
population. These recommendations include reducing antipsychotic medication dose or
switching antipsychotic medications, enhancing smoking cessation efforts, sharing
electronic health records between physical and mental health care systems, and promoting
integration of care.
</p>