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The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort

Nowakowska, Magdalena; Zghebi, Salwa S.; Ashcroft, Darren M.; Buchan, Iain; Chew-Graham, Carolyn; Holt, Tim; Mallen, Christian; Van Marwijk, Harm; Peek, Niels; Perera-Salazar, Rafael; Reeves, David; Rutter, Martin K.; Weng, Stephen F.; Qureshi, Nadeem; Mamas, Mamas A.; Kontopantelis, Evangelos

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Authors

Magdalena Nowakowska

Salwa S. Zghebi

Darren M. Ashcroft

Iain Buchan

Carolyn Chew-Graham

Tim Holt

Christian Mallen

Harm Van Marwijk

Niels Peek

Rafael Perera-Salazar

David Reeves

Martin K. Rutter

Stephen F. Weng

Mamas A. Mamas

Evangelos Kontopantelis



Abstract

Background: The presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions.

Methods: We used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation.

Results: More people living in the most deprived areas had ≥ 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics.

Conclusions: Comorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.

Citation

Nowakowska, M., Zghebi, S. S., Ashcroft, D. M., Buchan, I., Chew-Graham, C., Holt, T., …Kontopantelis, E. (2019). The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Medicine, 17(1), Article 145. https://doi.org/10.1186/s12916-019-1373-y

Journal Article Type Article
Acceptance Date Jun 20, 2019
Online Publication Date Jul 25, 2019
Publication Date Jul 25, 2019
Deposit Date Jul 31, 2019
Publicly Available Date Mar 28, 2024
Journal BMC Medicine
Electronic ISSN 1741-7015
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 17
Issue 1
Article Number 145
DOI https://doi.org/10.1186/s12916-019-1373-y
Keywords Comorbidity; Type 2 diabetes mellitus; CPRD; Prevalence; Primary care
Public URL https://nottingham-repository.worktribe.com/output/2363686
Publisher URL https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1373-y
Additional Information This article is distributed under the terms of the Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/

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