Type 2 diabetes mellitus in people with intellectual disabilities: Examining incidence, risk factors, quality of care and related complications. A population-based matched cohort study.

Summary

In a nationwide matched cohort (n≈495,869), people with intellectual disabilities had a markedly higher adjusted incidence of type 2 diabetes (IRR 6.91), with impaired mobility a strong risk factor (OR 7.72). They received fewer recommended tests and had a 12% higher risk of macrovascular complications, underscoring care inequities.

Key Findings

• Adjusted incidence rate ratio for T2DM was 6.91 (95% CI 5.81–8.22) in people with intellectual disabilities versus matched controls.
• Impaired mobility strongly associated with incident T2DM (OR 7.72, 95% CI 5.87–10.15).
• Lower receipt of HbA1c/cholesterol tests and eye/foot exams; 12% higher risk of macrovascular complications.

Clinical Implications

Implement earlier and more intensive T2DM screening and risk management in people with intellectual disabilities, address mobility-related risks, and ensure equitable delivery of HbA1c/lipid testing and retinopathy/foot examinations to reduce macrovascular complications.

Limitations

• Observational design may have residual confounding and misclassification in EHR coding.
• Follow-up intensity and health care access variability could bias detection of outcomes.

Future Directions

Test targeted screening/care pathways in randomized or quasi-experimental designs for people with intellectual disabilities; evaluate mobility-focused interventions to reduce T2DM risk and complications.