Preventing and Treating Diabetes in Canadian Adults With Intellectual and Developmental Disabilities

Combined use of anti-platelet aggregation drugs and shujin huoluo decoction for diabetic peripheral vascular disease: enhanced therapeutic efficacy

OBJECTIVE

To investigate the clinical effect of anti-platelet aggregation drugs combined with Shujin Huoluo Decoction (SJHLD, a decoction for relaxing muscles and activating collaterals) in the treatment of diabetic peripheral vascular disease.

METHODS

A total of 130 patients with diabetic peripheral vascular disease were retrospectively included in this study and divided into two groups. In the monotherapy group, 65 patients were treated with cilostazol (CTZ) monotherapy; in the combined group, 65 patients were treated with CTZ combined with SJHLD. The treatment efficacy, inflammatory indexes, blood glucose and lipid levels, ultrasound parameters, and hemorheology of the two groups were compared before and after treatment.

RESULTS

Both groups showed significant improvements in walking distance and skin temperature of the toes, with more pronounced changes observed in the combined group (P < 0.05). After treatment, inflammatory markers decreased notably in both groups (P < 0.05). Blood glucose and lipid levels decreased markedly, with a more substantial reduction in lipid levels observed in the combined group (P < 0.05). Lower limb arterial conditions improved markedly in both groups, with greater improvements seen in the combined group (P < 0.05). Additionally, the pulsatile index and blood flow velocity in the ankle-brachial and dorsalis pedis arteries increased markedly in both groups, with the combined group showing a greater improvement (P < 0.05). Hemorheology parameters also decreased significantly in both groups, with the combined group showing a more significant reduction (P < 0.05). The effective treatment rate was significantly higher in the combined group (P < 0.05).

CONCLUSIONS

The combination of CTZ and SJHLD significantly improves lower limb function, ultrasound parameters, and blood flow, enhancing treatment efficiency in patients with diabetic peripheral vascular disease. This therapeutic approach offers valuable clinical guidance and warrants consideration for use in diabetic patients.

Promoting health literacy in people with intellectual disabilities via explanatory videos: scoping reviews

People with intellectual disabilities have a significant lower level of health literacy compared to the general population which exacerbates participation of the target group. Therefore, people with ID shall be strengthened with regard to health literacy. Explanatory videos are a promising approach to reach that goal. Yet, explanatory videos are neither frequently used in people with intellectual disabilities nor is known a lot about the efficacy of explanatory videos. Two scoping reviews were conducted. One review is an update of an existing review dealing with Health Literacy in people with intellectual disabilities. The second review focused on explanatory videos and people with intellectual disabilities. CINAHL, PubMed, PubPsych and Web of Science were searched. Health Literacy and intellectual disability: nine publications were identified: five publications focused on several aspects of Health Literacy in the target group. A total of four publications discussed ways to increase Health Literacy in people with intellectual disabilities. One publication described existing barriers in accessing and understanding health-related information for people with intellectual disabilities. Explanatory videos and intellectual disability: No eligible publications could be found. The conceptual discussion on health literacy in people with intellectual disabilities is continuing. Nevertheless, often only small subgroups are addressed. Although ideas for increasing health literacy in people with intellectual disabilities exist, there are only little interventions that were scientifically evaluated. There are publications that deal with explanatory videos in the context of intellectual disability, but they do not focus on the efficacy of these videos or special needs of the target group.

A systematic review of the health literacy of adults with lifelong communication disability: Looking beyond accessing and understanding information

OBJECTIVE

To determine the a) extent to which people with lifelong communication disability are included in health literacy research, b) level of health literacy of people with lifelong communication disability, c) methods applied to measure the health literacy of people with lifelong communication disability, d) barriers and facilitators mediating the health literacy of people with lifelong communication disability, and e) outcomes of health literacy interventions for people with lifelong communication disability.

METHODS

We searched for studies relating to health literacy, people with lifelong communication disability, and key areas of the Sørensen et al. (2012) health literacy model (i.e., accessing, understanding, appraising, applying health information, personal/environmental/systemic barriers and facilitators).

RESULTS

Analysis of 60 studies demonstrated that this population is not well represented. Insufficient research exists to inform statements on level of health literacy or methods used to measure health literacy of this population. Barriers and facilitators appear consistent with those applicable to the general population. Health literacy intervention outcomes were variable.

CONCLUSION

Significant gaps exist in the research which has primarily focused on people with intellectual disability accessing and understanding health information.

PRACTICE IMPLICATIONS

Findings can inform policies, practice, and future research on health literacy and people with lifelong communication disability.

Addressing Metabolic Comorbidity in Individuals With Intellectual and Developmental Disability on Antipsychotics: A Clinical Case Series

PURPOSE/BACKGROUND

Individuals with intellectual and developmental disabilities (IDDs) are at increased risk for serious metabolic comorbidities, which is further exacerbated by the high rate of antipsychotic use in this population. There is currently a lack of literature on effective treatment options for antipsychotic-induced weight gain and metabolic abnormalities in IDD. This case series reports on the clinical use of metformin in patients with IDD on antipsychotics.

METHODS/PROCEDURES

We conducted a retrospective review of patients in a novel clinical service at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada for adults with IDD experiencing antipsychotic-related weight gain and other metabolic aberrations. Charts were reviewed for weight and other metabolic outcome measures before and after commencing metformin treatment.

FINDINGS/RESULTS

In 11 patients referred to this clinic, the mean weight loss while on metformin treatment was 11.1 kg, with over 50% of the sample achieving clinically meaningful weight loss of >7%. Additional adaptive changes were observed for fasting glucose, glycated hemoglobin, triglyceride, and high-density lipoprotein cholesterol levels.

IMPLICATIONS/CONCLUSIONS

In line with its use in severe mental illness, metformin may be a safe, effective, and accessible treatment option for patients with IDD experiencing metabolic adverse effects of antipsychotic medication. Further research and randomized controlled trials are needed to examine the efficacy of metformin in this population.

Prevalence of diabetes in people with intellectual disabilities and age- and gender-matched controls: A meta-analysis

BACKGROUND

This meta-analysis aims to: (i) describe the pooled prevalence of diabetes in people with intellectual disabilities, (ii) investigate the association with demographic, clinical and treatment-related factors and (iii) compare the prevalence versus age- and gender-matched general population controls.

METHODS

Pubmed, Embase and CINAHL were searched until 01 May 2021. Random effects meta-analysis and an odds ratio analysis were conducted to compare rates with controls.

RESULTS

The trim- and fill-adjusted pooled diabetes prevalence amongst 55,548 individuals with intellectual disabilities (N studies = 33) was 8.5% (95% CI = 7.2%-10.0%). The trim- and fill-adjusted odds for diabetes was 2.46 times higher (95% CI = 1.89-3.21) (n = 42,684) versus controls (n = 4,177,550). Older age (R²  = .83, p < .001), smoking (R²  = .30, p = .009) and co-morbid depression (R²  = .18, p = .04), anxiety (R²  = .97, p < .001), and hypertension (R²  = 0.29, p < .001) were associated with higher diabetes prevalence rates.

CONCLUSIONS

Our findings demonstrate that people with intellectual disabilities are at an increased risk of diabetes, and therefore routine screening and multidisciplinary management of diabetes is needed.

Metabolic syndrome and its components in people with intellectual disability: a meta-analysis

BACKGROUND

People with intellectual disability have an increased risk for cardiovascular diseases and associated premature mortality. Metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. The aim of this meta-analysis was to describe the pooled prevalence of MetS and its components in people with intellectual disability taking into account variations in demographic, clinical and treatment-related variables.

METHODS

Pubmed, Embase and CINAHL were searched until 5 August 2020 for studies reporting cross-sectional data on prevalences of MetS and its components in people with intellectual disability. Two independent reviewers extracted data. Random effects meta-analyses with subgroup and meta-regression analyses were employed.

RESULTS

The pooled MetS prevalence after adjusting for publication bias was 22.5% [95% confidence interval (CI) = 16.8%-29.6%; N studies = 10; n participants = 2443, median age at study level = 38.5 years; 52% male]. Abdominal obesity was observed in 52.0% (95% CI = 42.0%-61.9%; I²  = 86.5; N = 5; n = 844), hypertension in 36.7% (95% CI = 26.1%-48.7%; N = 6; n = 926), hypertriglyceridaemia in 23.5% (95% CI = 18.8%-28.9%; N = 5; n = 845), low high-density-lipoprotein-cholesterol in 23.4% (95% CI = 19.3%-28.0%; N = 6; n = 917), and hyperglycaemia in 10.2% (95% CI = 7.6%-13.3%; N = 5; n = 845). Meta-regression revealed that a higher MetS frequency was moderated by older age (coefficient = 0.03; standard error = 0.01, 95% CI = 0.008 to 0.055; N = 19; n = 2443) and a higher proportion of people on antidepressants in the study (coefficient = 7.24; standard error = 0.90, 95% CI = 5.48-9.00; N = 4; n = 546). There were insufficient data comparing MetS in people with intellectual disability with age-matched and gender-matched controls.

CONCLUSIONS

Considering that more than one fifth of people with intellectual disability have MetS, routine screening and multidisciplinary management of metabolic abnormalities in people with intellectual disability is needed. Attention should be given to older people and those on antidepressants.