Quality of diabetes care among persons with intellectual disabilities and type 2 diabetes: A nationwide cohort study.

Abstract

To investigate the quality of diabetes care among persons with intellectual disabilities (ID) and type 2 diabetes (T2DM). A nationwide matched cohort study including 4219 persons with ID and T2DM and 16,863 age- and sex-matched persons with T2DM but without ID. Quality of care was assessed through national guideline indicators, including process measures (HbA1c, low-density lipoprotein cholesterol (LDL-C), urine albumin-creatinine ratio (UACR), foot screening) and result measures (HbA1c and LDL-C targets) from 2015 to 2021. Associations were analysed with mixed-effects logistic regression and reported as odds ratios with 95% confidence intervals. Compared with persons without ID, those with ID had higher odds of annual HbA1c assessment (OR=1.58, 95% CI 1.38-1.80) and foot screening (OR=2.14, 95% CI 1.86-2.47), but lower odds of UACR (OR=0.64, 95% CI 0.60-0.70). LDL-C assessments were similar. Achievement of HbA1c ≤ 7.0% (≤53 mmol/mol) was comparable (OR=1.01, 95% CI 0.90-1.14), whereas high HbA1c ≥ 8.6% (≥70 mmol/mol) was more frequent among persons with ID (OR=1.39, 95% CI 1.22-1.58). LDL-C ≤ 2.5 mmol/L was more common among persons with ID (OR=1.36, 95% CI 1.20-1.53). Persons with ID and T2DM have higher odds of poor glycaemic control despite increased monitoring, highlighting the need for improved management tailored to specific needs.