Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Abstract

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

Diabetes in adults with intellectual disability: prevalence and associated demographic, lifestyle, independence and health factors

“…We did not find any evidence of a relationship between diabetes and the potentially modifiable lifestyle, independence and health factors that we investigated. The prevalence of diabetes in this adult population was 7.3%, which is lower than previous estimates and unadjusted European general population figures of around 9% (International Diabetes Federation 2017; Dunkley et al 2017b). This is likely to reflect the younger age distribution in our study cohort as compared with the general population (i.e.…”

“…The prevalence of diabetes in this adult population was 7.3%, which is lower than previous estimates and unadjusted European general population figures of around 9% (International Diabetes Federation ; Dunkley et al . ). This is likely to reflect the younger age distribution in our study cohort as compared with the general population (i.e.…”

Multimorbidity and lifestyle factors among adults with intellectual disabilities: a cross‐sectional analysis of a UK cohort

“…The STOP Diabetes study, including full details of data collection, has been described elsewhere (Dunkley et al . ; Dunkley et al . ) but, briefly, involved a population‐based screening programme of adults (aged 18–74 years) with ID in Leicestershire, UK.…”

“…This study involved a cross-sectional analysis of the 'STOP Diabetes' cohort. The STOP Diabetes study, including full details of data collection, has been described elsewhere (Dunkley et al 2017a;Dunkley et al 2017b) but, briefly, involved a population-based screening programme of adults (aged 18-74 years) with ID in Leicestershire, UK. Participants were recruited between December 2012 and September 2015 from general practices and specialist ID services.…”

Type 2 diabetes and glucose intolerance in a population with intellectual disabilities: the STOP diabetes cross‐sectional screening study

“…Most studies have previously been unable to distinguish between type 2 diabetes and other forms of diabetes (McVilly et al , MacRae et al ). Recent meta‐analytic evidence, derived from a small number of studies ( n = 5) where type 2 diabetes has been considered separately from other types of diabetes, suggests an overall pooled prevalence of 7.6% (Dunkley ). However, this rate includes known cases (i.e.…”