TOPLINE:

In a cohort of approximately 0.3 million patients with type 2 diabetes (T2D), those with learning disabilities exhibited better glycaemic control but faced a higher risk for all-cause and diabetes-related mortality than those without learning disabilities.

METHODOLOGY:

• Researchers conducted an observational cohort study using primary care health records to evaluate the effect of learning disabilities on glycaemic control, progression to microvascular and macrovascular complications, and mortality in 280,300 patients newly diagnosed with T2D who had at least 6 months of follow-up.
• At the time of T2D diagnosis, 2074 patients (mean age, 51.08 years; 57.28% men) were identified as having a learning disability and were compared with 278,226 patients without such disabilities (mean age, 62.43 years; 56.03% men); mean follow-up durations were 5.29 years for those with a learning disability and 6.03 years for those without.
• A1c levels were measured at 2 and 5 years post-diagnosis, with poor glycaemic control being defined as A1c levels above 7%; the time to insulin initiation beyond 2 years after T2D diagnosis was also evaluated as a proxy for severe disease.
• Other outcomes included the development of macrovascular and microvascular complications from 6 months post-diagnosis, as well as all-cause and diabetes-related mortality.

TAKEAWAY:

• Patients with learning disabilities had poorer glycaemic control at the time of T2D diagnosis than those without; they were also more likely to have severe obesity and live in highly deprived areas.
• However, at 2 and 5 years post-diagnosis, the odds of poor glycaemic control were significantly lower in patients with learning disabilities than in those without (adjusted odds ratio [aOR], 0.82; P = .001 and aOR, 0.81; P = .004, respectively).
• Patients with learning disabilities faced nearly twice the risk for both all-cause mortality (adjusted hazard ratio [aHR], 1.81; P < .001) and diabetes-related mortality (aHR, 2.01; P < .001) compared with those without.
• They also showed a marginal tendency to initiate insulin therapy earlier than those without learning disabilities (P = .052); no significant difference in the risk for microvascular and macrovascular complications was seen between the two groups.

IN PRACTICE:

"Any shortcomings in healthcare for people with learning disabilities may be related to general barriers to healthcare access for those with learning disabilities, such as overlooked pain, lower screening rates, and insufficient training of staff," the authors wrote.

"Reasonable adjustments by healthcare staff to understand the needs of those with learning disabilities could be beneficial, such as allowing sufficient time and space for information exchanges and consultations," they added.

SOURCE:

This study was led by Archie Wing, London School of Hygiene & Tropical Medicine, London, England. It was published online on September 02, 2025, in BMJ Open Diabetes Research & Care.

LIMITATIONS:

Patients with learning disabilities had shorter follow ‐ up periods. Moreover, 17.44% of those with a learning disability were diagnosed after their T2D diagnosis, potentially leading to exposure misclassification. Information on glycaemic control was missing, particularly among those with learning disabilities.

DISCLOSURES:

This study did not receive any specific source of funding. One author reported being a part of Genes & Health programme, which was partly funded by a Life Sciences Consortium comprising various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.