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. 2017 Nov 23;17(1):272.
doi: 10.1186/s12877-017-0658-2.

Prevalence and treatment of diabetes mellitus and hypertension among older adults with intellectual disability in comparison with the general population

Anna Axmon  1   2 , Gerd Ahlström  3 , Peter Höglund  4
Affiliations

Prevalence and treatment of diabetes mellitus and hypertension among older adults with intellectual disability in comparison with the general population

Anna Axmon et al. BMC Geriatr. .

Abstract

Background: Diabetes mellitus and hypertension are risk factors for cardiovascular disease, which is the most common cause of death in the world. People with intellectual disability (ID) have been reported to have high rates of both these disorders. The aim of this study was to describe and compare prevalence ratios of diabetes mellitus and hypertension between older adults with ID and their age peers in the general population, and to describe and compare treatment patterns in these two groups.

Methods: This is a Swedish register-based study, in which we established a cohort of people aged 55+ years and who had received support for those with ID in 2012 (n = 7936). We also established a same-sized referent cohort from the general population matched by sex and year of birth. Information on diagnoses of diabetes mellitus and hypertension, and prescription of drugs for these disorders, were collected from national registers for the period 2006-2012. The two cohorts were compared using generalized linear models (GLM).

Results: People with ID were 20% more likely than the general population to have a diagnosis of diabetes mellitus, and 26% more likely to have prescription of drugs for diabetes mellitus. People in the general population were 81% more likely to have a diagnosis of hypertension, and 9% more likely to have a prescription of drugs for hypertension. Among those with diabetes, ID was associated with higher occurrence of prescription of insulin combination drugs and sulfonylureas, but lower occurrence of prescription of dipeptidyl peptidase (DPP) 4-inhibitors and exenatide/liraglutide. Among those with hypertension, ID was associated with higher occurrence of prescription of diuretics, but lower occurrence of prescription of calcium channel blockers and angiotensin II antagonists.

Conclusions: Treatment regimens among people with ID tended to include older types of medication compared with what was prescribed in the general population. To ensure that this is medically appropriate and not due to failure to update the treatment regimen, it is important to investigate if the people with ID and diabetes mellitus or hypertension are subjected to the same regular drug reviews that are recommended for older adults in general.

Keywords: Aged; Cardiovascular disease risk factors; Drug prescription; Middle-aged.

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Conflict of interest statement

Author’s information

AA (PhD, associate professor) is a statistician and epidemiologist. GA (RN, PhD, professor) has long experience in research regarding disability and health care for the elderly. PH (MD, PhD, professor) has expertise in pharmacology as well as in ethics.

Ethics approval and consent to participate

Approval was obtained from the Regional Ethical Review Board in Lund (no. 2013/15). The National Board of Health and Welfare performed a separate secrecy review in 2014 before providing access to the data. All analyses were performed using anonymized datasets. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Data in the present study is based on anonymized information provided by two official national registrars, The National Board of Health and Welfare and Statistics Sweden. These authorities provide anonymized information for research purposes to individual researchers once the study has been vetted and approved by the Regional Ethical Review Board according to Swedish ethical review regulations. Because of the requirement of anonymized data, each individual could not be asked for consent to participate; instead active refusal of participation was applied. This was done by publishing information about the planned study in the national newspaper” Dagens Nyheter” and in UNIK, the magazine of The Swedish National Association for People with Intellectual Disability (FUB), which is printed in 22,000 copies. The target audience for the UNIK magazine are mainly members (people with ID) and their families. The advertisement was written in two versions, whereof one was easy-to-read text. The advertisement presented the study and contained information on how to contact the research manager (GA) by phone, email or mail in order to opt out of the study. The research manager (GA) was then responsible for contacting the national registrars so that those who opted out were excluded before the registrars provided any data to the research manager.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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