Management of diabetes in French prisons: a cross-sectional study

Weight gain and chronic disease progression among individuals incarcerated in Canadian federal penitentiaries: a retrospective cohort study

Purpose

Very little is known about how weight gain during incarceration influences the health of people living in Canadian federal penitentiaries. To fill this knowledge gap, this study aims to determine how the observed weight gain influenced the development of obesity-related chronic diseases during incarceration.

Design/methodology/approach

This retrospective cohort study examined the association between weight gain and obesity-related chronic diseases for 1,420 participants incarcerated in federal penitentiaries in Ontario, New Brunswick and Nova Scotia. To participate, individuals had to be incarcerated for at least six months at the time of the study (2016–2017). Current anthropometric data were measured or taken from medical records, then compared to anthropometric data at the beginning of incarceration (mean follow-up of 5.0 years) to determine weight change (kg) and body mass index change (kg/m2) during incarceration. Then, information about obesity-related chronic diseases was drawn from the participants’ medical records.

Findings

Chi-square and nonparametric median comparison tests were performed to detect statistically significant changes in anthropometric data, to determine if a relationship was present. This study observed a significant association between weight gain and disease development for many types of obesity-related chronic diseases (e.g. cancer, type 2 diabetes, hypertension, dyslipidemia and sleep apnea). This confirmed an association between weight gain and chronic disease development in the prison population.

Originality/value

Participants who gained a significant amount of weight, during incarceration, were also more frequently diagnosed with obesity-related chronic diseases. These findings suggest that weight gain may contribute to the deterioration of peoples’ health during incarceration.

Diagnosed diabetes and optimal disease control of prisoners in Catalonia

Objectives

To determine the prevalence of diagnosed diabetes (DD) and its control amongst prisoners in Catalonia.

Materials and methods

Transversal study carried out in four Catalan prisons between April and May 2016. The prevalence of DD in inmates was calculated by intentional sampling and collecting the following variables about: a) type of diabetes, value of glycosylated hemoglobin (HbA1c) and treatment; b) comorbidities; c) epidemiological and prison variables; knowledge of hyperglycaemia/hypoglycaemia, and e) participation in educational activities. Optimal control was considered to exist if Hb1A<7.5% and high risk if Hb1Ac >9%. Test x² was used in order to study the association among qualitative variables. Multivariate analysis was carried out using logistic regression to determine variables associated with disease control.

Results

The study group considered 4,307 male patients, 50.2 years of average age. Ninety-three cases of DD were detected (prevalence 2.16%). 22.6% were treated with insulin, 51.6% with oral antidiabetics (OAD) and 25.8% with both. Type 1 users were younger, thinner, diagnosed at a younger age, heavy drug users and acknowledged to know how to act in the event of hyperglycaemia/hypoglycaemia. Optimal control was more common in type 2 diabetics, but multivariate analysis only associated it with OAD treatment.

Discussion

The prevalence observed in DD is much lower than that of the population outside prison and may be underestimated. Optimal control is low, and risk is very high, the results may be biased by the type of population, frequently drug-dependent and with few healthy habits. It is recommended to implement diabetes programmes or improve existing ones in order to increase the diagnosis and management of the disease.

Cost of an Integrated Care Program to Reduce ED Visits During Diabetic Prisoner Court Hearings

Diabetic events occurring during court hearings previously required emergency medical services (EMS) transport to the emergency department (ED). A new process was implemented whereby the provincial court (PC) was notified by the detention center of diabetes status of prisoners scheduled for court later that day, enabling a community nursing services provider to provide on-site diabetes assessment and treatment at the PC. During the 13-month pre-implementation phase, there were 10 incidents of diabetic distress resulting in an ED visit at a total cost of $797.58/prisoner, including police service personnel, EMS, and ED staff/physician. During the 12.5-month postimplementation phase, insulin was administered on-site during 72 court dates at a cost of $161.93/prisoner. The new process for managing diabetic needs of prisoners during court dates resulted in a substantial cost savings in terms of police services and health care personnel and improved the immediacy and quality of care for prisoners.

Prison health care: a review of the literature

The prison population is increasing and the health problems of prisoners are considerable. Prison is designed with punishment, correction and rehabilitation to the community in mind and these goals may conflict with the aims of health care. A literature review showed that the main issues in prison health care are mental health, substance abuse and communicable diseases. Women prisoners and older prisoners have needs which are distinct from other prisoners. Health promotion and the health of the community outside prisons are desirable aims of prison health care. The delivery of effective health care to prisoners is dependent upon partnership between health and prison services and telemedicine is one possible mode of delivery.