Management of diabetes and hypertension in people with multiple sclerosis

Objective: We aimed to determine the adequacy of disease control and intensity of treatment for diabetes and hypertension in individuals with multiple sclerosis (MS) as compared to individuals without MS using the Canadian Primary Care Sentinel Surveillance System (CPCSSN). Methods: We identified individuals aged >= 18 years, with >= 1 record in the CPCSSN data as of March 31, 2016. We applied a validated case definition to identify individuals with MS, hypertension and diabetes. Hypertension was defined as controlled if the average blood pressure was <140/90, while diabetes was defined as controlled if the average HbA1c was <= 7%. Treatment intensity for each condition was described as the number of related drugs prescribed per patient. We used multivariable logistic regression analysis to determine the association between MS and (i) hypertension control (BP <140/90), or (ii) diabetes control (HbA1c <= 7%) accounting for age, sex, region of residence, body mass index, number of physician visits in the last two years, and depression. Results: : Among 971,799 individuals meeting the inclusion criteria, 2926 (0.3%) had MS of whom 666 (22.8%) had hypertension and 298 (10.2%) had diabetes. On univariate analysis, as compared to persons without MS, persons with MS had 25% increased odds of achieving good control of hypertension (OR 1.26; 95%CI: 1.05-1.33), and 31% increased odds of achieving good diabetes control (1.31; 95%CI: 1.00-1.71). On multivariable analysis, persons with MS no longer had increased odds of achieving good control of hypertension (OR 1.04; 95%CI: 0.79-1.37) or diabetes control (OR 1.15; 95%CI: 0.76-1.74). In a sensitivity analysis using an HbA1c <= 7%, individuals with MS had increased odds of achieving the target (OR 1.57; 95%CI: 1.02-2.44). The mean (SD) number of anti-hypertensive medications used was lower among persons with MS (0.18 [0.81]) than among persons without MS (0.40 [1.35], p = 0.001). The mean (SD) number of medications used for diabetes did not differ between persons with MS (2.4 [1.9]) and without MS (2.5 [1.8], p = 0.56). Conclusion: : In the Canadian primary care setting, comorbid MS does not adversely affect the control of hypertension or diabetes.