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Weight management, diet support needed in adults with type 2 diabetes, intellectual disabilities
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Adults with non-insulin-requiring type 2 diabetes and intellectual disabilities are more likely to have obesity and report low levels of physical activity, despite having glycemic control that is similar to that of the general population, researchers reported in a cross-sectional, case-finding study.
“People with intellectual disability are less likely to receive appropriate care for diabetes and other chronic health conditions, and tend to have reduced self-management abilities,” Louise D. Bryant, PhD, associate professor in medical psychology at the Leeds Institute of Health Sciences at the University of Leeds, United Kingdom, and colleagues wrote. “There is some evidence that they have poorer outcomes, including more hospital admissions.”
Bryant and colleagues analyzed data from 147 adults with non-insulin-requiring type 2 diabetes and a mild to moderate learning disability who were living in the community, recruited mainly from primary care offices in three districts of West Yorkshire, United Kingdom. Researchers asked general practitioners to cross-reference diabetes and intellectual disability registers; intellectual disability was established through an assessment of functional deficits in daily activities, educational and social attainment and support needs, and day-to-day cognitive function. Participants completed interviews at home with a supporter, answering questions on diabetes management (diet, physical activity, medication, self-care awareness and engagement with health services); feelings about body weight, diet and having diabetes; and preferences for further assistance with diabetes management. Researchers also identified the role of supporters in diabetes management.
Within the cohort, mean HbA1c was 7.1%; mean BMI was 32.9 kg/m², with 20% of participants having BMI at least 40 kg/m². More than half of participants had total cholesterol of at least 4 mmol/L; 75% of these participants had QRISK-2 estimated 10-year risk for cardiovascular disease of at least 10%, which is the National Institute for Health and Care Excellence recommended target for intervention.
Medication use; self-care practice
In baseline interviews, 80% of participants reported taking oral antidiabetes medications, with 30% reporting nonadherence at least once a week (8.5%) or “most days” (3%). Participants’ reasons for nonadherences included forgetting or being too busy (67%), followed by “don’t like swallowing it” (15%). Most participants reported that supporters prompted them to take medications.
During 12 months, most participants reported seeing their general practice nurse (92%), attending a retinal screening (80%) and seeing their general practitioner (63%), with 49% reporting seeing a podiatrist. However, only 7% of participants reported seeing a dietitian. Most participants reported that they would like further help to look after their diabetes.
Researchers observed high levels of self-reported comorbidities, with 37% on registers for CVDs, 33% on registers for obesity and 28% on registries for mental health problems in addition to registers for diabetes and intellectual disability. Nearly one-third of participants reported that they “felt poorly” either sometimes or most of the time.
Lifestyle; support persons
More than 40% of participants reported that they “usually or often” consumed fats or high-fat snacks, and more than 60% reported “usually or sometimes” consuming “too many sweets” and fizzy drinks. Most adults lived with a support person (71%), usually in a house with staff present (41%) or with immediate family or a partner. Levels and consistency of support were highly variable, however, according to researchers.
Researchers also observed a decrease in BMI, but not HbA1c, according to whether participants reported feeling “miserable/sad” or not (mean BMI, 34.3 kg/m² vs. 30.4 kg/m²), were happy with their diet or not (mean BMI, 30.4 kg/m² vs. 36.6 kg/m²) or were happy with their weight or not (mean BMI, 29.5 kg/m² vs. 34.8 kg/m²). HbA1c values were lower among participants who named a supporter with their diabetes management compared with those who did not, but those results were not statistically significant, according to researchers.
“Only 7% of our sample reported having contact with a dietitian, suggesting that support with diet is very limited,” the researchers wrote. “Strategies that take into account both social circumstance and intellectual capacity are required; for example, excess weight is more tangible that ‘blood sugar,’ an important consideration in a population that works best with concrete concepts.”
The researchers noted that the number of participants who reported wanting help with diabetes management was “encouraging;” however, specialized services are limited.
“The urgent clinical need is therefore to provide reasonable adjustments to existing weight management and diabetes services that are more closely linked to routine health checks,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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