fact file 34New guidance on the management of Type 2 diabetes in adults with a learning disabilityThe NHS RightCare Pathway for Diabetes (Reasonable Adjustments for People with a Learning Disability who have Diabetes) offers guidance on diabetes services for adults with a learning disability, and self-management for patients. Diabetes UK also provides resources for professionals and patients, aimed at improving the care of those for whom self-management is difficult without additional support. Dr Louise Bryant and Professor Allan House, Leeds Institute of Health Sciences, present the main recommendations

organisational working – especially between NHS diabetes services, NHS mental health services, where most learning disability services sit, and local authorities, where weight management and exercise services are managed.

• Ensure structured education programmes are available in a suitable format for people with a learning disability.

• Ensure that all commissioned services make the reasonable adjustments mandated by the Equality Act 2010 and meet the requirements of the NHS Information Standard.

Primary care clinical teams• Ensure staff are trained in the basic skills required for

working with people with a learning disability, including the ability to assess mental capacity.

• Ensure the practice’s learning disability register is comprehensive by implementing the most up to date search strategies to identify eligible patients on your list, and cross-reference with the diabetes register.

0345 123 2399*| info@diabetes.org.uk | www.diabetes.org.uk*Calls may be recorded for quality and training purposes.

A charity registered in England and Wales (215199) and in Scotland (SC039136). ©Diabetes UK 2018

Individuals with a learning disability constitute approximately 1–2 per cent of the adult population. Our best estimate is that about 10 per cent of adults with a learning disability have Type 2 diabetes. Risk factors include high levels of obesity, which is reported in 35–40 per cent of this population. Overprescribing of psychotropic drugs to people with a learning disability who have mental health problems or challenging behaviour is a recognised concern, especially as these medications are associated with weight gain. People with a learning disability are disproportionately represented in lower socioeconomic groups and are less likely to buy fresh food and have limited ability to pay for exercise activities. In addition, the lives of people with a learning disability are often characterised by low levels of control – for example, over what they eat and when they can exercise.

Moreover, people with a learning disability are less likely to receive appropriate care for chronic health conditions and tend to have reduced self-management abilities. While research is limited, there is some evidence of poorer outcomes for people with a learning disability and diabetes, including increased hospital admissions compared with the general population.

These problems have been highlighted in national reports on the poor health and lower life expectancy of adults with a learning disability. Where at all possible it is expected that they will be addressed in mainstream health services, which should make ‘reasonable adjustments’ to support equal access for disabled people.

RecommendationsThe main recommendations on delivering care to this population are given below, with links to useful resources for planning services.

Commissioners• Ensure the needs of adults with a learning disability are

specifically addressed in contracts with providers of diabetes services and weight management programmes.

• Through joint planning, avoid barriers to cross-

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SELECTED REFERENCES

1 Balogh R, Lake J, Lin E et al (2015). Disparities in diabetes prevalence and preventable hospitalizations in people with intellectual and developmental disability: a population-based study. Diabetic Medicine 32 (2); 235–242

2 Emerson E (2011). Health status and health risks of the ‘hidden majority’ of adults with intellectual disability. Intellectual and Developmental Disabilities 49 (3); 155–165

3 Taggart L, Coates V and Truesdale-Kennedy M (2013). Management and quality indicators of diabetes mellitus in people with intellectual disabilities. Journal of Intellectual Disability Research 57 (12); 1152–1163

SELECTED RESOURCES

1 Diabetes UK. www.diabetes.org.uk/learning-disability

2 NHS (2017). www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2017/11/rightcare-pathway-diabetes-reasonable-adjustments-learning-disability-2.pdf

3 The General Medical Council (2018). www.gmc-uk.org/learningdisabilities

4 The Royal College of General Practitioners (2010). www.rcgp.org.uk/learningdisabilities

5 Mencap. www.mencap.org.uk/learning-disability-explained/resources-healthcare-professionals

6 Public Health England (2017). www.gov.uk/government/publications/reasonable-adjustments-for-people-with-learning-disabilities

7 NHS England (2016). Accessible information Standard. www.england.nhs.uk/ourwork/accessibleinfo

8 NHS England (2017). www.england.nhs.uk/publication/guides-to-help-staff-support-people-with-access-needs

• Ensure all eligible adults with a learning disability have an Annual Health Check, including screening for diabetes in those without a diagnosis. Research shows that most adults with a learning disability would like more help with managing their diabetes, with changing their diet and losing weight, and with being more physically active. Reasons for wanting to lose weight are typically the same as they are in the general population. Use the Health Check as an opportunity to discuss obesity and physical activity levels and offer referral to community services for support with weight management, increasing activity or smoking cessation.

• When diabetes self-management is compromised by mental health problems, consider referral to local learning disability or mental health services. Comorbidity can define complex cases, who then meet criteria for entry on a learning disability register and referral to specialist services, even when the learning disability is otherwise not severe enough.

• Ensure the availability of a good range of accessible (Easy Read) materials – see resource list below.

• Be alert to the risk of hypoglycaemia in a population who find it difficult to recognise or report symptoms; remember that hypoglycaemia may mimic, facilitate or follow an epileptic seizure and therefore it is important to check the blood glucose level when a fit has occurred.

• Check attendance at retinal screening, foot and dental care, and the other checks listed in Diabetes UK’s 15 Healthcare Essentials (www.diabetes.org.uk/essentials)

• When at all possible, involve a supporter in key assessment and decision-making consultations. Be aware that a person’s supporter may also have a learning disability.

Acute trusts• Develop joint care pathways for adults with a learning

disability and diabetes who present acutely with medical problems – for example, by involving a learning disability liaison nurse in all cases.

Learning disability services• Create a diabetes register, particularly covering groups

of patients at especially high risk, such as those on longer-term antipsychotic medication.

• Implement training in diabetes-related competencies for all staff.

• Use audit to ensure current practice in diabetes care follows NICE recommended guidelines.

Community services• Ensure that reasonable adjustments (including accessible

written materials) are available to support referral to, and use of, services for diabetes care or prevention, weight management, dental care and screening programmes.

• Plan delivery of services to encourage involvement of supporters.

0345 123 2399*| info@diabetes.org.uk | www.diabetes.org.uk*Calls may be recorded for quality and training purposes.

A charity registered in England and Wales (215199) and in Scotland (SC039136). ©Diabetes UK 2018

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