SUN-634 - Bridging the Gap: Improving Metabolic Health in Patients with Serious Mental Illness with Novel Diabetes Therapies and Team-Based Care.

Background and

Objective: Patients with serious mental illness (SMI) are highly vulnerable to adverse cardiometabolic outcomes, yet data on novel treatments like incretin analogs and sodium glucose cotransporter 2 inhibitors (SGLT-2i) in this population are scarce. To address this, we established a weekly integrated diabetes care clinic at the University of Rochester’s Medicine-In-Psychiatry Service Primary Care site. Our aim was to improve and study cardiometabolic outcomes in patients with SMI and diabetes.

Methods: Patients with SMI and uncontrolled diabetes or those not on incretin analog/SGLT-2i were referred. Follow-up occurred every 1-3 months for at least 6 months, including clinical assessments, lab tests, medication adjustments (per American Diabetes Association guidelines), and self-management tips. Our main outcomes were changes in HbA1c, weight, and the use of incretin analogs, SGLT-2i, and personal continuous glucose monitoring (CGM) devices. Data were analyzed using an electronic health record self-service reporting tool (SlicerDicer), Excel, and SPSS.

Results: Between 9/2022 and 12/2025, 82 patients with SMI and diabetes participated (average age 51, 50% female, 41% Black, 35% White, 17% Hispanic, >90% had type 2 diabetes). After 6-12 months, patients achieved significant reductions in HbA1c (0.85%) and weight (3.4kg). SGLT-2i and incretin analog use approximately doubled, and CGM use increased sixfold. We performed two key subgroup analyses:
(1) HbA1c Responders (HI, ≥0.5% reduction, n=30) vs. Non-responders (LO, < 0.5% reduction, n=30): The HI group saw a 2.24% HbA1c decrease, while the LO group's HbA1c increased by 0.55%. The LO group had a significantly lower baseline weight and HbA1c, and was less likely to be started on an SGLT-2i.
(2) Treatment-specific outcomes: Incretin analog alone (n=17): Significant HbA1c reduction (0.8%) and substantial weight loss (8.1 kg) were noted. SGLT-2i alone (n=10): Significant HbA1c reduction was seen (1%), but no weight loss. Both incretin analog + SGLT-2i (n=9): Both drugs were most effective for glycemic control (HbA1c reduction 2.1%), with 5 kg weight loss.

Conclusions: Integrated diabetes care leads to meaningful metabolic improvements in patients with SMI and diabetes. SGLT-2i are most effective for improving glycemic control, while incretin analogs improve both glycemic and weight control. Combining both therapies is additive for glycemic control but not for weight control, a finding that may be unique to this patient population and warrants further investigation.

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