Diabetes mortality is much higher for people with a learning disability

People with a learning disability who have type 2 diabetes are at higher risk of dying from the condition, despite having better overall blood glucose control.

The study, published in BMJ Open Diabetes Research & Control, found that although they had similar risks of vascular complications, people with learning disabilities were 20% more likely to progress faster to severe disease and the need for insulin therapy than those who didn’t have learning disabilities.

They were also more likely to be taking medication for diabetes and high blood pressure and to have more complications related to diabetes at the time of their diagnosis.

The authors suggested that future research into the mechanisms behind this could help reduce health disparities for people with type 2 diabetes and learning disabilities.

Research into type 2 diabetes and complications

The authors wanted to assess the potential impact of learning disabilities on the outcomes of type 2 diabetes, including blood glucose control, progression to microvascular and macrovascular complications, initiation of insulin therapy (proxy for severe disease), and risk of death.

They extracted anonymised medical records for 352,215 adults newly diagnosed with type 2 diabetes in primary care between January 2004 and January 2021 from the UK Clinical Practice Research Datalink (CPRD).

Of these, 280,300 met the eligibility criteria for inclusion in the study, 2074 of whom had a learning disability when they were diagnosed.

People with a learning disability diagnosed with type 2 diabetes tended to be younger (with an average age of 51 vs. 64 years) and had a shorter monitoring period. They also included higher proportions of men, people of White ethnicity, people living with severe obesity and in areas of most significant deprivation than those without learning disabilities.

The authors said: “Our finding of higher rates of insulin initiation in those with learning disabilities warrants further investigation into whether this is due to poorer glycemic control at presentation (and therefore faster advancing type 2 diabetes) or due to having a greater degree of clinical surveillance.

“Future research into the mechanisms behind this could help reduce health disparities for people with [type 2 diabetes] and learning disabilities.”

Type 2 diabetes and learning disability

They added that type 2 diabetes in those with learning disabilities can be challenging as it requires a substantial amount of monitoring and management, which they may not always be able to do, potentially compromising their blood glucose control.

Additionally, reasonable adjustments by healthcare staff to understand the needs of individuals with learning disabilities could be beneficial, such as allowing sufficient time and space for information exchange and consultations.

A previous study published in the British Journal of Learning Disabilities identified 12 barriers to optimal diabetes care for adults with learning disabilities. This included a low level of diabetes knowledge and understanding, as well as systems that do not allow reasonable adjustments.

The study found that barriers to optimal care, as reported in published studies, included formal or informal caregivers lacking diabetes knowledge and understanding, community living arrangements, and a lack of accessible information.

It was recommended that staff and caregivers receive training to address the need for patient autonomy in diabetes self-management. This could be provided as part of structured education programmes or as part of a separate educational package targeting professionals and caregivers.

Alison Bloomer

Alison Bloomer is Editor of Learning Disability Today.

See Full Bio