Diabetes in people with developmental disability

The prevalence of diabetes in people with developmental disability is unknown, but a 2014 systematic review suggested it may be higher than the general population (8.6 vs 5.1%). Evidence also suggests that people with developmental disability might be at greater risk of diabetes than the general population. This may reflect higher levels of obesity and inactivity in this population. Levels of screening for diabetes complications have been found to be lower among adults with intellectual disabilities.

Diabetes is common in specific genetic conditions (eg Prader–Willi syndrome, Down syndrome) and people with mitochondrial genetic disorders.

Review risk factors for type 2 diabetes and consider testing (eg fasting plasma glucose):

  • annually in people identified to be at high risk
  • opportunistically in children and adolescents who are overweight or obese
  • at least every 3 years in adults with a developmental disability other than Down syndrome
  • people with Down syndrome over 30 years of age every 3 years using glycated haemoglobin or fasting plasma glucose levels even if asymptomatic
  • adults with comorbid obesity and Down syndrome every 2 to 3 years from age 21 years.

Some antipsychotic drugs (eg olanzapine) predispose people to hyperglycaemia and will need specific monitoring; see the Psychotropic guidelines.

Preventive health care and health promotion is an essential component of diabetes risk reduction.

In people with developmental disability, diabetes management is often complicated by difficulty:

  • maintaining adequate levels of physical activity
  • adhering to dietary restrictions
  • managing insulin injections and glucose monitoring (especially in people who live independently or are averse to pinpricks)
  • understanding the long-term implications (eg complications).

For detailed discussion of diabetes and its treatment, see Principles of management of diabetes. Refer people with insulin-dependent diabetes to a specialist (eg paediatrician, endocrinologist).

The Queensland Centre for Intellectual and Developmental Disability has a website with information about diabetes for people with intellectual disability and their support people; see ‘Diabetes to the point’.