Diabetes in people with an intellectual disability: a systematic review of prevalence, incidence and impact

McVilly, K., McGillivray, J., Curtis, A., Lehmann, J., Morrish, L., & Speight, J. (2014). Diabetes in people with an intellectual disability: a systematic review of prevalence, incidence and impact. Diabetic Medicine31. 8. P. 897-904.

Abstract

Aims

To establish the prevalence and incidence of Type 1 and Type 2 diabetes in people with an intellectual and developmental disability and determine their impact on health and well-being and to appraise the evidence available to inform good practice in diabetes management for people with intellectual and developmental disabilities.

Methods

We conducted separate searches of multiple databases (EMBASE, CINAHL, MEDLINE, PsycINFO, SCOPUS, Web of Science, PUBMED and Cochrane Library) to find relevant articles.

Results

A total of 13 studies were identified: 13 addressed the prevalence of diabetes in people with intellectual and developmental disability, three addressed the impact of diabetes on their health and well-being and three addressed the management of diabetes. The prevalence of diabetes in people with intellectual and developmental disability remains uncertain, and the incidence of diabetes in this group of people is unknown. There is some evidence to support the assertion that people with intellectual and developmental disability might be at greater risk of diabetes than the general population. Overall, the quality of the evidence on which to base prevention and management strategies is variable.

Conclusions

There is a paucity of research focusing on the prevalence, incidence and impact of diabetes among people with intellectual and developmental disability. Further research is needed to inform policy and practice in this area and, in particular, work is needed to develop methodologies, evaluation tools, educational resources and diabetes care support services appropriate to the needs of people with intellectual and developmental disability.

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Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes #Covid19RftLks

Kianmehr, H. et al. (2022). Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes. JAMA Netw Open. 4. e227705. doi:10.1001/jamanetworkopen.2022.7705

This piece of research set out to quantify potential gains in life expectancy (LE) among people with type 2 diabetes (T2D) associated with lowering glycated hemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) toward optimal levels.

Key Points

Question
  What potential gains in life expectancy (LE) are associated with lowering glycated hemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) toward optimal levels in people with type 2 diabetes (T2D)?

Findings

This decision analytical model using data from 421 adults with T2D showed that compared with individuals from the highest BMI, HbA1c, SBP, and LDL-C population quartile, those from the lowest BMI, HbA1c, SBP, and LDL-C population quartile had 3.9, 3.8, 1.9, and 0.9 years of additional LE, respectively.

Meaning  

These findings suggest that achieving recommended goals is likely to extend the LE of people with T2D.

Full paper available from JAMA

JAMA: Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes

Kianmehr. H., et al. (2022). Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes. JAMA Netw Open.5. 4 :e227705. doi:10.1001/jamanetworkopen.2022.7705

Key Points

Question  What potential gains in life expectancy (LE) are associated with lowering glycated hemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) toward optimal levels in people with type 2 diabetes (T2D)?

Findings  This decision analytical model using data from 421 adults with T2D showed that compared with individuals from the highest BMI, HbA1c, SBP, and LDL-C population quartile, those from the lowest BMI, HbA1c, SBP, and LDL-C population quartile had 3.9, 3.8, 1.9, and 0.9 years of additional LE, respectively.

Meaning  These findings suggest that achieving recommended goals is likely to extend the LE of people with T2D.

Abstract

Importance  Improvements in control of factors associated with diabetes risk in the US have stalled and remain suboptimal. The benefit of continually improving goal achievement has not been evaluated to date.

Objective  To quantify potential gains in life expectancy (LE) among people with type 2 diabetes (T2D) associated with lowering glycated hemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) toward optimal levels.

Design, Setting, and Participants  In this decision analytical model, the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes microsimulation model was calibrated to a nationally representative sample of adults with T2D from the National Health and Nutrition Examination Survey (2015-2016) using their linked short-term mortality data from the National Death Index. The model was then used to conduct the simulation experiment on the study population over a lifetime. Data were analyzed from January to October 2021.

Exposure  The study population was grouped into quartiles on the basis of levels of HbA1c, SBP, LDL-C, and BMI. LE gains associated with achieving better control were estimated by moving people with T2D from the current quartile of each biomarker to the lower quartiles.

Main Outcomes and Measures  Life expectancy.

Results  Among 421 individuals, 194 (46 per cent) were women, and the mean (SD) age was 65.6 (8.9) years. Compared with a BMI of 41.4 (mean of the fourth quartile), lower BMIs of 24.3 (first), 28.6 (second), and 33.0 (third) were associated with 3.9, 2.9, and 2.0 additional life-years, respectively, in people with T2D. Compared with an SBP of 160.4 mm Hg (fourth), lower SBP levels of 114.1 mm Hg (first), 128.2 mm Hg (second), and 139.1 mm Hg (third) were associated with 1.9, 1.5, and 1.1 years gained in LE in people with T2D, respectively. A lower LDL-C level of 59 mg/dL (first), 84.0 mg/dL (second), and 107.0 mg/dL (third) were associated with 0.9, 0.7, and 0.5 years gain in LE, compared with LDL-C of 146.2 mg/dL (fourth). Reducing HbA1c from 9.9 per cent (fourth) to 7.7 per cent (third) was associated with 3.4 years gain in LE. However, a further reduction to 6.8 per cent (second) was associated with only a mean of 0.5 years gain in LE, and from 6.8 per cent to 5.9 per cent (first) was not associated with LE benefit. Overall, reducing HbA1c from the fourth quartile to the first is associated with an LE gain of 3.8 years.

Conclusions and Relevance  These findings can be used by clinicians to motivate patients in achieving the recommended treatment goals and to help prioritize interventions and programs to improve diabetes care in the US.

Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes [paper]

Diabetes UK: £2.2 million new dawn project to help more people go in to remission

Diabetes UK | £2.2 million new dawn project to help more people go in to remission

Diabetes UK have joined forces with the National Institute for Health Research (NIHR) to fund a new £2.2 million project, called NewDAWN, led by Professors Susan Jebb and Paul Aveyard at the University of Oxford to give more people newly diagnosed with type 2 diabetes the chance of going into remission.

Diabetes UK £2.2 million new dawn project to help more people go in to remission

National diabetic foot care report

Office for Health Improvement and Disparities | April 2022 | National diabetic foot care report

The national diabetes foot care report presents data for England on lower-limb amputations and hospital admissions for diabetes-related foot disease.

Image shows footprints with blue marbled paint effect

Key Information

During the three-year period of 2017/18 to 2019/20:

  • There were 171,759 foot disease-related hospital admissions for patients with diabetes.
  • 97,175 individual patients had a hospital admission for foot disease and 34 per cent had more than one admission over the three years.
  • There were 7,957 major amputations with a directly standardised rate of 8.1 major amputations per 10,000 population with diabetes per year.
  • There were 21,738 minor amputations with a directly standardised rate of 22.1 minor amputations per 10,000 population with diabetes per year.
  • Patients with diabetes that are male, from the most deprived areas, aged over 65 or of white ethnicity had greater risk of amputation.

National diabetic foot care reportpix

See also:

National diabetes foot care report: April 2022 [statistics]

In the news:

BBC News Fear over high rates of diabetes foot amputations

£50m donation for type 1 diabetes research to lead the race for a cure

JDRF | n.d. | £50m donation for type 1 diabetes research to lead the race for a cure

Today (25 April 2022), as part of celebrations marking the centenary anniversary of the first use of insulin to treat type 1 diabetes, a new partnership has been announced between the Steve Morgan Foundation (SMF), JDRF and Diabetes UK to transform the lives of people with type 1 diabetes and lead the race towards cures.

£50m donation for type 1 diabetes research to lead the race for a cure

See also:

Diabetes UK Biggest-ever philanthropic gift to diabetes research brings type 1 cure closer

Diabetes UK: Recovering Diabetes Care: Preventing the Mounting Crisis

Diabetes UK | April 2022 | Recovering Diabetes Care: Preventing the Mounting Crisis

A new report, published on 20/04/22 by Diabetes UK as part of its Diabetes Is Serious campaign, shows the scale of the problem and sets out a series of calls to UK Government to tackle it.   

The report is informed by a survey of more than 10,000 people living with and affected by diabetes, and revealed: 

  • Almost half (47 per cent) had experienced difficulties managing their condition in 2021.   
  • More than two-thirds 63 per cent attributed this in part to not having sufficient access to their healthcare team, rising to 71 per cent in the most deprived areas of the country.  
  • One in six reported no contact whatsoever about their diabetes with their healthcare team since before the pandemic.   

These findings are backed up by NHS figures which report that just 36 per cent of people with diabetes in England received all their recommended care checks in 2020/21, compared with 57 per cent in 2019-201.   

The survey also revealed stark health inequalities. It showed that people from the most deprived areas of the country were more likely to have experienced difficulties managing their diabetes, with 56 per cent of people in the most deprived areas saying they had experienced problems compared to 44 per cent in the least deprived.

Diabetes UK is calling for:

  • A recovery plan from UK Government specifically addressing the challenges facing diabetes services, including staffing constraints, so that people with the condition can access the vital support they need.   
  • A renewed commitment to improving outcomes for people with, and at risk of, diabetes in the forthcoming refresh of the NHS Long Term Plan – and the further investment needed to make this happen.
  • A cross-government strategy to tackle health inequalities in the forthcoming White Paper on Health Disparities.   
  • Integrated Care Systems to urgently draw up plans to catch up on the backlog of diabetes care, with the aim of ensuring everyone with diabetes has had a review of the key care processes and their care plan by the end of 2022.
Image source: Diabetes. org.uk Image is the front cover of the report

See also:

Diabetes UK Diabetes is serious 2022

Medscape Post-Pandemic Diabetes Recovery Plan Needed Before Lives are ‘Needlessly Lost

National Paediatric Diabetes Audit Annual Report 2020/21

Health Quality Improvement Partnership | April 2022 | National Paediatric Diabetes Audit Annual Report 2020/21

The National Paediatric Diabetes Audit (NPDA) has published its latest annual report. The report covers the health checks (care processes) and outcomes for children and young people with diabetes who have attended Paediatric Diabetes Units (PDUs) during the period from 1 April 2020 to 31 March 2021, aged 0-24 years on the first day of the audit period.

Image source: hqip.org.uk

The report found that the incidence of Type 1 diabetes increased significantly in 2020/21 amongst those aged 0-15, from 25.6 new cases per 100,000 in 2019/20 to 30.9 in 2020/21 – an increase of 20.7 per cent. Other key findings include:

  • 3,662 children and young people newly diagnosed with Type 1 diabetes received care from paediatric diabetes units in 2020/21 – 789 more than the average number newly diagnosed and being managed in a PDU between 2013/14-2019/20.
  • The number of children and young people with Type 2 diabetes being managed within a PDU increased from 866 in 2019/20 to 973 in 2020/21, with the numbers diagnosed within the audit year having increased from 201 in 2019/20 to 230 in 2020/21.
  • The impact of the COVID-19 pandemic on paediatric diabetes care can be seen in lower completion rates of all recommended health checks and the smaller percentage of children and young people starting insulin pump therapy if diagnosed in 2020/21, compared to previous years.

In addition, an increase in the use of real time continuous glucose monitors (rtCGM) from 19.4 per cent in 2019/20 to 27.9 per cent in 2020/21 was found, with increases observed across all deprivation quintiles and ethnic groups. As such, the report recommends that paediatric diabetes teams and hospital commissioners should ensure that a real time continuous glucose monitor is available to all children and young people with diabetes who wish to use one, supported by an education programme.

National Paediatric Diabetes Audit Annual Report 2020/21

Association of statin and/or renin-angiotensin-aldosterone system modulating therapy with mortality in adults with diabetes admitted to hospital with COVID-19 #Covid19RftLks

Harris, S. et al (2022). Association of statin and/or renin-angiotensin-aldosterone system modulating therapy with mortality in adults with diabetes admitted to hospital with COVID-19: A retrospective multicentre European study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. https://doi.org/10.1016/j.dsx.2022.102484

Highlights

• No association between COVID-19 related mortality and use of renin-angiotensin-aldosterone system inhibitor or statin therapy in people with diabetes

.• There was no evidence of an association dependent on ethnicity or type of diabetes.

• Significant variation in renin-angiotensin-aldosterone system inhibitor and statin use across Europe, variable mortality needs further exploration.

• This study reassures clinicians to continue prescribing both statin and renin-angiotensin-aldosterone system inhibitor therapy throughout COVID-19 pandemic.

Abstract

Background & aims

To assess the impact of pre-admission renin-angiotensin-aldosterone system inhibitor (RAASi) and statin use on mortality following COVID-19 hospitalization in adults with pre-existing diabetes.

Methods

Retrospective cohort study of adults with diabetes admitted to ninety-nine participating hospitals in the United Kingdom, France and Spain during the first wave of the COVID-19 pandemic. Logistic regression models adjusted for demographic factors and comorbidity were used to describe associations with mortality in hospital or within 28 days of admission and individual or combined RAASi and statin therapy prescription followed by a country level meta-analysis.

Results

Complete data were available for 3474 (42.6 per cent) individuals. Prescribing patterns varied by country: 25–50 per cent neither RAASi nor statin therapy, 14–36 per cent both RAASi and statin therapy, 9–24 per cent RAASi therapy alone, 12–36 per cent statin alone. Overall, 20–37 per cent of patients died within 28 days. Meta-analysis found no evidence of an association between mortality and prescription of RAASi therapy (OR 1.09, CI 0.78–1.52 (I2 22.2 per cent)), statin (OR 0.97, CI 0.59–1.61 (I2 72.9 per cent)) or both (OR 1.14, CI 0.67–1.92 (I2 78.3 per cent)) compared to those prescribed neither drug class.

Conclusions

This large multicentre, multinational study found no evidence of an association between mortality from COVID-19 infection in people with diabetes and use of either RAASi, statin or combination therapy. This provides reassurance that clinicians should not change their RAASi and statin therapy prescribing practice in people with diabetes during the COVID-19 pandemic.

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