We posted last week about the  challenges faced by people with learning disabilities and diabetes. This New Zealand study looked at the additional challenges associated with self-management, which for people who do not have learning disabilities is encouraged. As the authors point out, this requires understanding of the disease and the implications of the actions of self management.

The researchers wanted to explore how to improve self-management of diabetes and to do this, worked with 14 adults with learning disabilities, 8 men and 6 women, 6 of whom had type 1 diabetes and 8 of whom had type 2 diabetes. Whilst type 1diabetes can occur at any age, it is most often diagnosed in children, adolescents, or young adults.

In type 1 diabetes, beta cells produce little or no insulin, needed to move blood sugar (glucose) into cells Type 2 diabetes occurs slowly over time and most people with the disease are overweight when they are diagnosed, a major risk factor in developing type 2 diabetes.

The adults with learning disabilities were interviewed, along with people who knew them well, who could act as key informants. The researchers also got the results from blood sugar level tests.

They found that the participants fell into three categories of understanding diabetes:

• those with good understanding
• those with some knowledge but limited understanding
• those with very basic knowledge and poor understanding.

All of the participants were involved in some way in the self management process, with particpants in all three groups having some level of understanding of the role of diet, blood sugar levels, and exercise in the management of diabetes. Key, as ever in the process was the nature of the support they received from others, even for those who had good understanding. They found that diabetes impacted significantly on most areas of the lives of the participants. In some cases it was cited as a reason for preventing them from living independently.

Strategies for helping to improve self management were suggested by the interviewers, which included the use of a “buddy” system to encourage exercise.

The researchers conclude that it is possible to involve adults with learning disabilites in self management of diabetes, but that critical to the success of this is education and support. They recommend that each individual needs a personal plan to ensure they receive bespoke education and support. They also suggest that peer-led education and user-friendly resources would ensure that people receive appropriate lifelong education and ongoing support.

Self-Management Abilities of Diabetes in People With an Intellectual Disability Living in New Zealand, Hale L et al, in Journal of Policy and Practice in Intellectual Disabilities, 8: 223–230