In an accompanying editorial in JAMA Psychiatry,1 Shuichi Suetani, MBChB and colleagues note that the Olfson et al research “is a reminder of how we are failing to meet the needs of people with schizophrenia.” They call on governments “to ensure priority is given to physical and mental health care of those with severe mental disorders” to prevent “a further widening of the life expectancy gap between the general population, whose life expectancy continues to rise, and that of people with severe mental disorders.”

Severe mental illness can also elevate risk for type 2 diabetes mellitus. For this reason, “the American Diabetes Association recommends annual diabetes screening for patients treated with antipsychotic medications, and public health administrators have targeted this population for improved health screening,” Christina Mangurian, MD, of the Department of Psychiatry at the University of California, San Francisco, CA, and colleagues note in JAMA.3



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However, due to limitations in public health records, “to our knowledge, no studies have examined screening rates in this highest-risk population of adults with severe mental illnesses,” such as schizophrenia and bipolar disorder. To investigate the prevalence of diabetes screening, they used data from a California healthcare system that included publicly insured adults with severe mental illnesses treated with antipsychotic medications; also assessed were characteristics predictive of screening.

They found that of 50,915 study subjects, 15,315, or 30.1%, received diabetes-specific screening, while 15,832 (31.1%) received no form of glucose screening over the course of a year.

“The strongest correlate of diabetes-specific screening was having at least 1 outpatient primary care visit during the period examined,” in addition to mental health services, Mangurian et al report. The adjusted prevalence ratio was 1.80 (95% CI: 1.62–2.00; P<0.001).

“This observation supports the value of burgeoning efforts to integrate behavioral health and primary care,” they write. “Growing evidence supports the value of screening for diabetes mellitus in higher-risk populations….”

They call for studies “to explore barriers to screening in this vulnerable population.”