Dr Tarrant (Psychiatric Bulletin, August 2006, 30, ) reaffirms the shortfalls in blood glucose monitoring in psychiatric practice, and we have confirmed this in two audits at a regional secure unit. The first (conducted in 2003) found that 30% of the in-patient sample on antipsychotic medication (an indicator of potential risk of hyperglycaemia) had random blood glucose measurement, and only one patient (who was diabetic) had regular blood glucose monitoring and measurement of glycosylated haemoglobin (HbAlc). The second audit (conducted in 2006) found that 58% of patients had their blood glucose measured at baseline, and half or less had appropriate monitoring.

These audits suggest that monitoring of blood glucose was unsatisfactory and recommendations (e.g. robust review of physical healthcare at care programmed approach meetings) to improve standards have subsequently been put into place. However, what is not known is the impact that the poor monitoring had on patient morbidity. One might predict that early detection and treatment of hyperglycaemia would prevent secondary problems such as coronary, renal and vascular complications in this patient population. It is therefore imperative that monitoring of blood glucose and other indicators of metabolic risk, such as HbA1c, lipid profiles and hormone levels (e.g. thyroid function tests), is undertaken whatever the setting (primary or secondary care and prisons) for all people on antipsychotic medication. It is also important that adherence to local/national protocols is audited regularly.