Wing Archie, Mathur Rohini
London School of Hygiene & Tropical Medicine, London, UK.
Royal United Hospital Bath NHS Trust, Bath, UK.
BMJ Open Diabetes Res Care. 2025 Sep 2;13(5):e004879. doi: 10.1136/bmjdrc-2024-004879.
Adults with learning disabilities in the UK have a substantially higher risk of developing type 2 diabetes mellitus (T2DM) than the general population. This study aimed to assess the impact of living with learning disabilities on T2DM control, therapeutic management, vascular outcomes, and mortality in UK primary care.
We conducted an observational cohort study using primary care electronic health records from the UK Clinical Practice Research Datalink. The study included adults newly diagnosed with T2DM from 2004 to 2021. The exposure was learning disability status at the time of diagnosis. Multivariable logistic regression was used to compare glycemic control at 5 years post-diagnosis between people with and without learning disabilities. Multivariable Cox regression was used to compare time to insulin initiation, macrovascular and microvascular complications, and mortality between people with and without learning disabilities.
Of 280 300 adults with T2DM included in the study, 2074 (0.74%) had a learning disability at T2DM diagnosis. After adjustment, people with learning disabilities had lower odds of poor glycemic control than those without learning disabilities 5 years after diagnosis (OR=0.81, 95% CI 0.70 to 0.94) and faster insulin initiation (HR=1.20, 95% CI 1.00 to 1.45) than those without learning disabilities. The risks of all-cause and diabetes-related mortality were doubled in those with learning disabilities (all-cause HR=2.15, 95% CI 1.82 to 2.54; diabetes-related HR=1.93, 95% CI 1.32 to 2.80). We found no difference in the risk of vascular complications.
Individuals with learning disabilities had better glycemic control but shorter time to insulin initiation. This may be related to more frequent diabetes monitoring, or faster advancing T2DM requiring quicker treatment intensification. Despite having similar risks of vascular complications, people with learning disabilities were at higher risk of death. Future research into the mechanisms behind this could help reduce health disparities for people with T2DM and learning disabilities.
在英国，有学习障碍的成年人患2型糖尿病（T2DM）的风险比普通人群高得多。本研究旨在评估在英国初级医疗保健中，患有学习障碍对T2DM控制、治疗管理、血管结局和死亡率的影响。
我们使用来自英国临床实践研究数据链的初级医疗保健电子健康记录进行了一项观察性队列研究。该研究纳入了2004年至2021年新诊断为T2DM的成年人。暴露因素为诊断时的学习障碍状态。采用多变量逻辑回归比较诊断后5年有和没有学习障碍的人群的血糖控制情况。采用多变量Cox回归比较有和没有学习障碍的人群开始使用胰岛素的时间、大血管和微血管并发症以及死亡率。
在纳入研究的280300名患有T2DM的成年人中，2074人（0.74%）在T2DM诊断时有学习障碍。经过调整后，有学习障碍的人在诊断后5年血糖控制不佳的几率低于没有学习障碍的人（OR = 0.81，95%CI 0.70至0.94），并且比没有学习障碍的人开始使用胰岛素的时间更快（HR = 1.20，95%CI 1.00至1.45）。有学习障碍的人全因死亡率和糖尿病相关死亡率增加了一倍（全因HR = 2.15，95%CI 1.82至2.54；糖尿病相关HR = 1.93，95%CI 1.32至2.80）。我们发现血管并发症的风险没有差异。
有学习障碍的个体血糖控制较好，但开始使用胰岛素的时间较短。这可能与更频繁的糖尿病监测有关，或者与T2DM进展更快需要更快加强治疗有关。尽管有学习障碍的人血管并发症风险相似，但他们的死亡风险更高。对此背后机制的未来研究可能有助于减少T2DM和学习障碍患者的健康差距。
