From the Guidelines
A 12-month prison sentence for a patient with Type 2 diabetes mellitus (T2DM), impaired liver and kidney function, and vitamin D deficiency poses significant risks, including disruption of diabetes management, increased risk of acute complications, and worsening of chronic conditions, compared to a public setting.
Risks in Correctional Institutions
- Disruption of medication and nutrition: Correctional institutions may not provide access to necessary medication and nutrition, leading to poor glycemic control and increased risk of complications 1.
- Limited access to medical personnel and equipment: Correctional institutions may not have adequate medical staff and equipment to manage diabetes and related comorbidities, leading to delayed diagnosis and treatment of complications 1.
- Increased risk of acute complications: The stress of incarceration, combined with poor diabetes management, increases the risk of acute complications such as hypoglycemia and hyperglycemia 1.
- Worsening of chronic conditions: The lack of access to regular medical care and poor management of diabetes and related comorbidities can lead to worsening of chronic conditions such as kidney disease and liver disease.
Importance of Standardized Care
- National standards of care: Correctional institutions should provide care that meets national standards, including access to medication, nutrition, and medical personnel 1.
- Written policies and procedures: Correctional institutions should have written policies and procedures for diabetes management, including training for medical and correctional staff 1.
- Regular monitoring and evaluation: Regular monitoring of blood glucose and A1C levels is crucial to ensure good glycemic control and prevent complications 1.
From the Research
Risks of a 12-month prison sentence for a patient with Type 2 diabetes mellitus (T2DM)
- A 12-month prison sentence may exacerbate the patient's T2DM, impaired liver and kidney function, and vitamin D deficiency due to potential inadequate access to medical care and poor living conditions 2, 3, 4.
- The patient's vitamin D deficiency may worsen in a prison setting, which could lead to further complications such as increased risk of diabetic kidney disease (DKD) and impaired bone health 2, 4, 5.
- The risk of 30-day readmission and length of stay in hospital may be higher for patients with T2DM, particularly if they have comorbidities such as impaired liver and kidney function 6.
Comparison to a public setting
- In a public setting, patients with T2DM may have better access to medical care, nutrition, and exercise, which could help manage their condition and prevent complications 3, 4, 5.
- However, patients with T2DM in a public setting may still face challenges such as inadequate access to healthcare, poor nutrition, and lack of physical activity, which could worsen their condition 6.
- Vitamin D supplementation may have beneficial effects on patients with T2DM and DKD, including improved vitamin D status, reduced proteinuria, and modified lipid metabolism 2, 4, 5.
Potential complications
- Patients with T2DM, impaired liver and kidney function, and vitamin D deficiency may be at risk of developing complications such as DKD, cardiovascular disease, and osteoporosis 2, 3, 4, 5.
- The patient's impaired liver and kidney function may be exacerbated by the prison environment, leading to further complications such as liver disease and kidney failure 2, 3.
- The patient's vitamin D deficiency may also increase their risk of developing infections, autoimmune diseases, and certain types of cancer 2, 4, 5.