Characterizing adults with Type 2 diabetes mellitus and intellectual disability: outcomes of a case-finding study

AIMS

To report the results of a case-finding study conducted during a feasibility trial of a supported self-management intervention for adults with mild to moderate intellectual disability and Type 2 diabetes mellitus, and to characterize the study sample in terms of diabetes control, health, and access to diabetes management services and support.

METHODS

We conducted a cross-sectional case-finding study in the UK (March 2013 to June 2015), which recruited participants mainly through primary care settings. Data were obtained from medical records and during home visits.

RESULTS

Of the 325 referrals, 147 eligible individuals participated. The participants' mean (sd) HbA1c concentration was 55 (15) mmol/mol [7.1 (1.4)%] and the mean (sd) BMI was 32.9 (7.9) kg/m2 , with 20% of participants having a BMI >40 kg/m2 . Self-reported frequency of physical activity was low and 79% of participants reported comorbidity, for example, cardiovascular disease, in addition to Type 2 diabetes. The majority of participants (88%) had a formal or informal supporter involved in their diabetes care, but level and consistency of support varied greatly. Post hoc exploratory analyses showed a significant association between BMI and self-reported mood, satisfaction with diet and weight.

CONCLUSIONS

We found high obesity and low physical activity levels in people with intellectual disability and Type 2 diabetes. Glycaemic control was no worse than in the general Type 2 diabetes population. Increased risk of morbidity in this population is less likely to be attributable to poor glycaemic control and is probably related, at least in part, to greater prevalence of obesity and inactivity. More research, focused on weight management and increasing activity in this population, is warranted.

A unique drug treatment program for pregnant and postpartum substance-using women in New York City: results of a pilot project, 1990-1995

In the 1980s, there was virtually no drug treatment for pregnant women in New York City, especially women who used crack cocaine. The purpose of the Parent and Child Enrichment (PACE) demonstration project was to assess the effectiveness of the one-stop shopping model of drug treatment for this population. Among PACE clients, 88% were primarily users of crack cocaine. The mean total length of stay was 100.0 days (median 55.5 days). Client retention 42 days after intake was 54.3%. This paper describes the essential components of this program model. "Long-stay" and "short-stay" clients were compared using urine toxicology tests and activity logs. In addition, the birth outcomes of clients were compared to two similar populations. A strong positive correlation was found between total length of stay and low rate of positive urine drug tests (UDTs). Infants of PACE long-stay clients had greater mean birth weight, less low birth weight, and less intrauterine growth retardation than the infants of the comparison groups. Fetal exposure to cocaine was decreased dramatically among women who were enrolled for 42 or more days during their pregnancy. This model of drug treatment for pregnant and postpartum women seems to improve mothers' lives, fetal drug exposure, and birth outcome significantly.

Breast-feeding initiation in New York City, 1979 to 1996

OBJECTIVES

The purpose of this study was to explore changes in breast-feeding initiation from 1979 to 1996 among infants born in New York City hospitals.

METHODS

All New York City hospitals were surveyed every 2 years. Hospital staff reported feeding method at newborn discharge.

RESULTS

New York City breast-feeding initiation rates increased consistently from 1979 to 1996 (from 29% to 58%, P < .0001), including 1984 to 1990, when rates decreased nationally.

CONCLUSIONS

A 1984 New York State regulation requiring each hospital to designate a lactation coordinator may have been associated with the continuing increases in breast-feeding initiation.

Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991

OBJECTIVES

We attempted to document the role of homicide and other injuries as causes of maternal death and to compare the risk of fatal injury among pregnant women with that in the general population.

STUDY DESIGN

We reviewed New York City medical examiner records of 2331 women aged 15 to 44 years who died of injury in 1987 through 1991. Pregnancies were identified from autopsy information.

RESULTS

A total of 115 (39%) of 293 deaths in currently or recently pregnant women were attributable to injury. These 115 deaths included homicide (63%), suicide (13%), motor vehicle crashes (12%), and drug overdoses (7%). Minority women were overrepresented among the injury deaths (black 53%, Hispanic 24%, white 19%). Recent substance use was documented in 48% of the injury deaths. Pregnancy was documented on only 35% of the 115 death certificates. The risk of fatal injury is similar for currently pregnant women and for women in the general population, except for an increased risk of homicide among pregnant black women.

CONCLUSIONS

Homicide and other injuries are major contributors to maternal mortality and should be (but rarely are) included routinely in maternal mortality surveillance systems. Prenatal and postpartum clinic visits represent an ideal time to implement interventions to prevent injuries among pregnant women.