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Recommendations for metabolic risk factor monitoring in patients with severe mental illness or on antipsychotic medication

Risk factor	Timing of assessment
	First year of antipsychotic				Ongoing monitoring*
	Baseline	6 weeks	3 months	12 months	Quarterly^¶	Annually^¶
Personal and family history of diabetes, hypertension, or cardiovascular disease	X					X
Smoking status, physical activity, diet^Δ	X	X	X		X
Weight, body mass index^Δ	X	X	X		X
Blood pressure^Δ	X	X	X		X
Fasting glucose or HbA1c^◊	X	X^§	X	X		X
Lipid profile (fasting or nonfasting)	X		X	X		X

* In subsequent years of antipsychotic and in patients with severe mental illness.
¶ Ongoing quarterly and annual monitoring is appropriate when health indicators are within the normal range. More frequent monitoring is indicated when health indicators are out of range.
Δ Assess regularly as part of general health maintenance.
◊ HbA1c is usually more practical to obtain than fasting glucose but either can be used.
§ Fasting glucose at 6 weeks is only recommended by European guidelines, but given evidence for rapid-onset hyperglycemia in some individuals starting antipsychotics, this represents prudent monitoring, especially for clozapine and olanzapine.

Adapted from: De Hert M, Detraux J, van Winkel R, et al. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nature Rev Endocrinol 2011; 8:114.

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