Individuals in the denominator whose most recent HbA1c level during the measurement year was greater than 9%.
Individuals 18 years and older with SMI and diabetes (based on medication or laboratory criteria) who underwent an HbA1c test during the measurement year.
The definition of Severe Mental Illness (SMI) includes schizophrenia, schizoaffective disorder, and bipolar disorder. Cardiovascular disease and its risk factors are more prevalent among individuals with SMI compared to the general population. For example, obesity is 1.5 to 2 times more common in adults with SMI, and the prevalence of diabetes is two to three times higher in this population. In addition, the onset of diabetes tends to occur at an earlier age among individuals with SMI, and both the frequency and severity of diabetes-related complications are greater in this group compared to the general population. These complications include a higher incidence of microvascular and macrovascular complications, acute metabolic dysregulation, and diabetes-related mortality. The mechanisms underlying these associations are complex and involve genetic, environmental, and behavioral factors, as well as the effects of antipsychotic pharmacotherapy (1)(2)(3)(4).
1. Vancampfort D, Correll CU, Galling B, Probst M, De Hert M, Ward PB, et al. Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: A systematic review and large scale meta-analysis. World Psychiatry. 2016 Jun 1;15(2):166–74.
2. Cohen A, Ashworth M, Askey A, Ismail K. Diabetes outcomes in people with severe mental illness. Vol. 68, British Journal of General Practice. Royal College of General Practitioners; 2018. p. 166–7.
3. Ashworth M, Schofield P, Das-Munshi J. Physical health in severe mental illness. Br J Gen Pract. 2017;67(663):436–7.
4. Holt RIG, Mitchell AJ. Diabetes mellitus and severe mental illness: Mechanisms and clinical implications. Nat Rev Endocrinol. 2015;11(2):79–89.
