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Zhang X, Xie J, You X, Gong H. Risk factors and drug discovery for cognitive impairment in type 2 diabetes mellitus using artificial intelligence interpretation and graph neural networks. Front Endocrinol (Lausanne) 2023; 14:1213711. [PMID: 37693358 PMCID: PMC10485700 DOI: 10.3389/fendo.2023.1213711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
Background Among the 382 million diabetic patients worldwide, approximately 30% experience neuropathy, and one-fifth of these patients eventually develop diabetes cognitive impairment (CI). However, the mechanism underlying diabetes CI remains unknown, and early diagnostic methods or effective treatments are currently not available. Objective This study aimed to explore the risk factors for CI in patients with type 2 diabetes mellitus (T2DM), screen potential therapeutic drugs for T2DM-CI, and provide evidence for preventing and treating T2DM-CI. Methods This study focused on the T2DM population admitted to the First Affiliated Hospital of Hunan College of Traditional Chinese Medicine and the First Affiliated Hospital of Hunan University of Chinese Medicine. Sociodemographic data and clinical objective indicators of T2DM patients admitted from January 2018 to December 2022 were collected. Based on the Montreal Cognitive Assessment (MoCA) Scale scores, 719 patients were categorized into two groups, the T2DM-CI group with CI and the T2DM-N group with normal cognition. The survey content included demographic characteristics, laboratory serological indicators, complications, and medication information. Six machine learning algorithms were used to analyze the risk factors of T2DM-CI, and the Shapley method was used to enhance model interpretability. Furthermore, we developed a graph neural network (GNN) model to identify potential drugs associated with T2DM-CI. Results Our results showed that the T2DM-CI risk prediction model based on Catboost exhibited superior performance with an area under the receiver operating characteristic curve (AUC) of 0.95 (specificity of 93.17% and sensitivity of 78.58%). Diabetes duration, age, education level, aspartate aminotransferase (AST), drinking, and intestinal flora were identified as risk factors for T2DM-CI. The top 10 potential drugs related to T2DM-CI, including Metformin, Liraglutide, and Lixisenatide, were selected by the GNN model. Some herbs, such as licorice and cuscutae semen, were also included. Finally, we discovered the mechanism of herbal medicine interventions in gut microbiota. Conclusion The method based on Interpreting AI and GNN can identify the risk factors and potential drugs associated with T2DM-CI.
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Affiliation(s)
- Xin Zhang
- Department of Pediatric, The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine, Zhuzhou, China
| | - Jiajia Xie
- Department of Ultrasound Imaging, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Xiong You
- Center of Rehabilitation diagnosis and Treatment, Hunan Provincial Rehabilitation Hospital, Changsha, China
| | - Houwu Gong
- College of Computer Science and Electronic Engineering, Hunan University, Changsha, China
- Military Medical Research Institute, Academy of Military Sciences, Beijing, China
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Owens R, Earle S, McNulty C, Tilley E. What works in community health education for adults with learning disabilities: A scoping review of the literature. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1268-1283. [PMID: 32346968 DOI: 10.1111/jar.12746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/05/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research suggests there is insufficient good quality information regarding the effectiveness of health education aimed at adults with intellectual disabilities. By analysing the literature, this review aimed to identify what constituted effectiveness in this context. METHOD Relevant evaluations were extracted from bibliographic databases according to pre-specified criteria. Papers were analysed using QSR NVivo 11 by developing a narrative synthesis and analytic framework that identified and explored text addressing the research question. RESULTS Twenty-two studies were included. The review identified two broad components of effective health education: mechanisms and context. Mechanisms included embedded programme flexibility, appropriate and accessible resources, and motivational delivery. An effective context included an accessible and supportive environment and longer term opportunities for reinforcement of learning. CONCLUSIONS Important gaps in the literature highlighted a need for further research addressing community learning experiences of adults with intellectual disabilities as well as the effectiveness of infection prevention programmes.
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Tyrer F, Ling S, Bhaumik S, Gangadharan SK, Khunti K, Gray LJ, Dunkley AJ. Diabetes in adults with intellectual disability: prevalence and associated demographic, lifestyle, independence and health factors. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:287-295. [PMID: 31976599 DOI: 10.1111/jir.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 10/01/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND As people with intellectual disabilities (ID) are now living longer, they are more at risk of developing non-communicable diseases, including type 2 diabetes mellitus. However, understanding of factors associated with diabetes for targeted management and prevention strategies is limited. This study aimed to investigate prevalence of diabetes in adults (aged ≥18 years) with ID and its relationship with demographic, lifestyle, independence and health factors. METHOD This was a cross-sectional analysis of interview data from 1091 adults with ID from the Leicestershire Learning Disability Register from 1 January 2010 to 31 December 2016. Logistic regression models were used to identify factors associated with diabetes in the study population. RESULTS The study population did not have healthy lifestyles: just under half reported having lower physical activity levels than people without ID of a similar age; one-quarter consumed fizzy drinks daily; and 20% consumed five or more fruit and/or vegetables per day. Prevalence of carer/self-reported diabetes was 7.3% (95% confidence interval 5.9-9.0). After adjustment, diabetes was positively associated with South Asian ethnicity (P = 0.03) and older age groups (P < 0.001). Diabetes was less common in people living with family members (P = 0.02). We did not find a relationship between any of the lifestyle, independence and health factors investigated. CONCLUSIONS A significant proportion of people with ID are living with diabetes. Diabetes management and prevention strategies should be tailored to individuals' complex needs and include consideration of lifestyle choices. Such strategies may want to focus on adults of South Asian ethnicity and people living in residential homes where prevalence appears to be higher.
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Affiliation(s)
- F Tyrer
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - S Ling
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - S Bhaumik
- Learning Disability Services, Leicestershire Partnership NHS Trust, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - S K Gangadharan
- Learning Disability Services, Leicestershire Partnership NHS Trust, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - A J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Ryan JM, Peterson MD, Matthews A, Ryan N, Smith KJ, O'Connell NE, Liverani S, Anokye N, Victor C, Allen E. Noncommunicable disease among adults with cerebral palsy: A matched cohort study. Neurology 2019; 93:e1385-e1396. [PMID: 31462583 PMCID: PMC6814410 DOI: 10.1212/wnl.0000000000008199] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/06/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the incidence of noncommunicable diseases between adults with and without cerebral palsy (CP). METHODS A cohort study was conducted using primary care data from the Clinical Practice Research Datalink. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of any noncommunicable disease, cancer, cardiovascular disease, type 2 diabetes mellitus, and respiratory disease between adults with and without CP. RESULTS The analysis included 1,705 adults with CP and 5,115 age-, sex-, and general practice-matched adults without CP. There was evidence from adjusted analyses that adults with CP had 75% increased risk of developing any noncommunicable disease compared to adults without CP (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.58-1.94). Specifically, they had increased risk of cardiovascular disease (HR 1.76, 95% CI 1.48-2.11) and respiratory disease (HR 2.61, 95% CI 2.14-3.19). There was no evidence of increased risk of cancer or type 2 diabetes mellitus. CONCLUSIONS Adults with CP had increased risk of noncommunicable disease, specifically cardiovascular and respiratory disease. These findings highlight the need for clinical vigilance regarding identification of noncommunicable disease in people with CP and further research into the etiology and management of noncommunicable disease in this population.
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Affiliation(s)
- Jennifer M Ryan
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK.
| | - Mark D Peterson
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK
| | - Anthony Matthews
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK
| | - Nicola Ryan
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK.
| | - Kimberley J Smith
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK
| | - Neil E O'Connell
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK
| | - Silvia Liverani
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK
| | - Nana Anokye
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK
| | - Christina Victor
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK
| | - Elizabeth Allen
- From the Department of Epidemiology and Public Health Medicine (J.M.R.), Royal College of Surgeons in Ireland, Dublin; Institute of Environment, Health and Societies (J.M.R., N.E.O., N.A., C.V.), Brunel University London, UK; Department of Physical Medicine and Rehabilitation (M.D.P.), University of Michigan-Medicine, Ann Arbor; Departments of Non-Communicable Disease Epidemiology (A.M.) and Medical Statistics (E.A.), London School of Hygiene and Tropical Medicine; Department of Cardiology (N.R.), Aberdeen Royal Infirmary, UK; Department of Interventional Cardiology (N.R.), Hospital Clínico San Carlos, Madrid, Spain; Department of Psychological Sciences (K.J.S.), Faculty of Health and Medical Sciences, University of Surrey, Guildford; and School of Mathematical Sciences (S.L.), Queen Mary University of London, UK
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Tyrer F, Dunkley AJ, Singh J, Kristunas C, Khunti K, Bhaumik S, Davies MJ, Yates TE, Gray LJ. Multimorbidity and lifestyle factors among adults with intellectual disabilities: a cross-sectional analysis of a UK cohort. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:255-265. [PMID: 30485584 DOI: 10.1111/jir.12571] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/25/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Multimorbidity [two or more conditions in addition to intellectual disability (ID)] is known to be more common among people with ID. However, the relationship between multimorbidity and lifestyle factors is currently unknown. The aim of this study was to determine the prevalence of multimorbidity in a population of adults with ID. We also aimed to identify risk factors, including lifestyle factors, for multimorbidity in this population. METHODS This was a cross-sectional analysis using data from a diabetes screening study of 920 adults aged 18-74 years with ID living in Leicestershire, UK. We described comorbidities and the prevalence of multimorbidity in this population. We explored the relationship between multimorbidity and age, gender, ethnicity, severity of ID, socio-economic status, physical activity, sedentary behaviour, fruit and vegetable consumption and smoking status using multiple logistic regression. RESULTS The prevalence of multimorbidity was 61.2% (95% CI 57.7-64.7). Multimorbidity was independently associated with being female (P < 0.001) and severe/profound ID (P = 0.004). Increasing age was of borderline significance (P = 0.06). Individuals who were physically inactive or sedentary were more likely to be multimorbid, independent of ability to walk, age, gender, severity of ID, ethnicity and socio-economic status (adjusted OR = 1.91; 95% CI 1.23-2.97; P = 0.004 and OR = 1.98; 95% CI 1.42-2.77; P < 0.001). After excluding probable life-long conditions (autism spectrum conditions, attention deficit hyperactivity disorders, epilepsy, cerebral palsy and other paralytic syndromes) as contributing comorbidities, the effect of sedentary behaviour, but not physical activity, remained (P = 0.004). We did not observe a relationship between multimorbidity, fruit and vegetable consumption and smoking status. CONCLUSIONS Multimorbidity presents a significant burden to people with ID. Individuals who were physically inactive or sedentary were more likely to be multimorbid, but further work is recommended to explore the relationship between multimorbidity and lifestyle factors using standardised objective measures.
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Affiliation(s)
- F Tyrer
- Department of Health Sciences Centre for Medicine, University of Leicester, Leicester, UK
| | - A J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - J Singh
- Department of Health Sciences Centre for Medicine, University of Leicester, Leicester, UK
| | - C Kristunas
- Department of Health Sciences Centre for Medicine, University of Leicester, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - S Bhaumik
- Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - T E Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - L J Gray
- Department of Health Sciences Centre for Medicine, University of Leicester, Leicester, UK
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Fagg J, Valabhji J. How do we identify people at high risk of Type 2 diabetes and help prevent the condition from developing? Diabet Med 2019; 36:316-325. [PMID: 30466172 PMCID: PMC6590463 DOI: 10.1111/dme.13867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
Abstract
AIMS To review the evidence regarding the identification of those at high risk of Type 2 diabetes and the conceptual and clinical criteria defining high risk, the prevention or delay of onset of Type 2 diabetes through lifestyle interventions, and the evolution of evidence from efficacy trials, through effectiveness trials in real-world settings, to implementation programmes at scale. METHOD The wide scope of this review precluded a systematic approach, therefore, we present a narrative review that highlights key themes and contemporary developments, drawing on landmark studies, previous systematic and expert reviews, and previous meta-analyses. RESULTS While the diagnostic thresholds for Type 2 diabetes are accepted, international consensus on whether, and how, to classify those at high risk of Type 2 diabetes has not been achieved. There is ongoing debate about which laboratory test to use and each test's corresponding inclusion threshold, about where the balance of clinical benefits and harms sit when defining thresholds, and about how affordability of subsequent preventative interventions might influence the derivation of such thresholds within any particular population. A remarkable international effort has seen the evolution of interventions for those at high risk move from efficacy trials, through effectiveness trials, to implementation at scale, and the evidence supporting each stage is reviewed. CONCLUSIONS To achieve healthcare system sustainability, many countries are now focusing on disease prevention. To complement population-level interventions that address the obesogenic environment, lifestyle interventions that empower individuals at high risk of Type 2 diabetes to modify this risk beneficially are now being implemented at scale.
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Affiliation(s)
- J. Fagg
- Public Health EnglandLondonUK
| | - J. Valabhji
- NHS EnglandImperial College Healthcare NHS TrustImperial College LondonLondonUK
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Taggart L, Truesdale M, Dunkley A, House A, Russell AM. Health Promotion and Wellness Initiatives Targeting Chronic Disease Prevention and Management for Adults with Intellectual and Developmental Disabilities: Recent Advancements in Type 2 Diabetes. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018; 5:132-142. [PMID: 30148038 PMCID: PMC6096852 DOI: 10.1007/s40474-018-0142-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW The aim of this paper was to review the recent international developments in health promotion and wellness initiatives targeting chronic disease prevention and management for adults with intellectual and developmental disabilities (IDD) targeting type 2 diabetes (T2D). RECENT FINDINGS There has been one diabetes prevention program (STOP) and two self-management T2D education programs (DESMOND-ID; OK diabetes) adapted for this population. All three programs have been adapted from other theoretically informed and tested programs developed for the general population. Each program has employed co-design and co-production techniques with all stakeholders. The three programs all target the high-risk lifestyle factors that can lead to T2D and contribute to poor glycaemia control, and have undertaken randomized-feasibility studies, the results of which are promising. SUMMARY This paper shows that any health promotion and wellness initiatives need to be tailored and reasonable adjustments made in order to address this population's cognitive impairments and communication difficulties.
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Affiliation(s)
- L. Taggart
- Institute of Nursing & Health Research, Ulster University, Room 12J19, Shore Road, Newtownabbey, Co Antrim BT37 0QB Northern Ireland
| | - M. Truesdale
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - A. Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, England
| | - A. House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - A. M. Russell
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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9
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Dunkley AJ, Tyrer F, Gray LJ, Bhaumik S, Spong R, Chudasama Y, Cooper SA, Ganghadaran S, Davies M, Khunti K. Type 2 diabetes and glucose intolerance in a population with intellectual disabilities: the STOP diabetes cross-sectional screening study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:668-681. [PMID: 28544066 DOI: 10.1111/jir.12380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/31/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) may be at increased risk of developing type 2 diabetes and cardiovascular disease, due to lifestyle factors, medications and other diagnosed conditions. Currently, there is lack of evidence on prevalence and prevention in this population. The aim of this study was to conduct a diabetes screening programme to determine prevalence of previously undiagnosed type 2 diabetes and impaired glucose regulation in people with ID. METHODS Screening was conducted in a variety of community settings in Leicestershire, UK. Adults with ID were invited via: general practices; the Leicestershire Learning Disability Register; ID psychiatric services; and some people directly contacted the research team due to publicity about the study. Screening involved collection of anthropometric, biomedical and questionnaire data. Type 2 diabetes and impaired glucose regulation were defined according to (venous) fasting plasma glucose or HbA1c, following current World Health Organisation criteria. RESULTS Nine hundred thirty adults (29% of those approached) participated. Mean age was 43 years, 58% were male and 16% of South Asian ethnicity. Most participants were either overweight or obese (68%). Diabetes status was successfully assessed for 675 (73%) participants: Nine (1.3%, 95% confidence interval 0.6 to 2.5) were found to have undiagnosed type 2 diabetes, and 35 (5.2%, 95% confidence interval 3.6 to 7.1) had impaired glucose regulation. Key factors associated with abnormal glucose regulation included the following: non-white ethnicity and a first degree family history of diabetes. CONCLUSIONS Results from this large multi-ethnic cohort suggest a low prevalence of screen-detected (previously undiagnosed) type 2 diabetes and impaired glucose regulation in adults with ID. However, the high levels of overweight and obesity we found emphasise the need for targeted lifestyle prevention strategies, which are specifically tailored for the needs of people with ID.
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Affiliation(s)
- A J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - F Tyrer
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK
| | - S Bhaumik
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicester, LE4 8PQ, UK
| | - R Spong
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Y Chudasama
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK
| | - S Ganghadaran
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicester, LE4 8PQ, UK
| | - M Davies
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
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