The barriers and facilitators to managing diabetes with insulin in adults with intellectual disabilities: A systemised review of the literature.
Cathy J Beresford, Olga Kozlowska
PMID 35983585WHAT IT FOUND
Adults with intellectual disabilities managing diabetes with insulin and their supporters described helpful support, accessible education, confidence, and flexible services.
Barriers included cognitive demands, needle fear, stigma, poor communication, and rigid services. These are themes, not evidence that any intervention works.
Key findings
01Support from other people was a central facilitator, including practical help with glucose checks and injections, plus encouragement and emotional support.
02Barriers included perceived inability to check glucose or inject insulin, lack of accessible education, low mood or motivation, low self-confidence, fear of needles and negative attitudes.
03Facilitators included perceived ability, supported understanding, goals, confidence, shared responsibility and reasonable adjustments such as adapted materials and flexible services.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The included studies were not all specifically about insulin; many looked at diabetes self-management more broadly. The review searched only three databases and excluded grey literature and papers not published in English. The included studies mainly involved people described as having mild or moderate intellectual disabilities, and almost no reference was made to people unable to participate in conventional verbal interviews. Several included studies did not collect the views of people with intellectual disabilities. One service improvement project was not quality assessed as a research paper and was given low weighting. The authors do not have an intellectual disability or diabetes, and their interpretations may differ from those with lived experience. The findings are themes from qualitative and mixed-methods studies, not measured effects of an intervention.
Declared interests
The authors declared no conflict of interest. The named funder is the National Institute for Health Research.
The easy way to misread this
Do not read the listed tools and training as proven ways to improve diabetes control. The review reports themes from qualitative studies; it did not test whether these adjustments changed blood glucose, complications, or self-management outcomes.