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

被引：184

作者：

Nowakowska, Magdalena ^{[1
,2
]}

Zghebi, Salwa S. ^{[1
,2
]}

Ashcroft, Darren M. ^{[1
,3
,4
]}

Buchan, Iain ^{[5
,6
]}

Chew-Graham, Carolyn ^{[7
]}

Holt, Tim ^{[8
]}

Mallen, Christian ^{[7
]}

Van Marwijk, Harm ^{[9
]}

Peek, Niels ^{[4
,5
,10
]}

Perera-Salazar, Rafael ^{[8
]}

Reeves, David ^{[1
,2
,11
]}

Rutter, Martin K. ^{[12
,13
]}

Weng, Stephen F. ^{[14
]}

Qureshi, Nadeem ^{[14
]}

Mamas, Mamas A. ^{[15
]}

Kontopantelis, Evangelos ^{[1
,2
,5
]}

机构：

[1] Univ Manchester, MAHSC, Ctr Primary Care & Hlth Serv Res, NIHR Sch Primary Care Res, 5th Floor Williamson Bldg, Manchester M13 9PL, Lancs, England

[2] Univ Manchester, MAHSC, Fac Biol Med & Hlth, Sch Hlth Sci,Div Populat Hlth Hlth Serv Res & Pri, 5th Floor Williamson Bldg, Manchester M13 9PL, Lancs, England

[3] Univ Manchester, MAHSC, Fac Biol Med & Hlth, Sch Hlth Sci,Div Pharm & Optometry, Manchester M13 9PL, Lancs, England

[4] Univ Manchester, NIHR Greater Manchester Patient Safety Translat R, Manchester M13 9PL, Lancs, England

[5] Univ Manchester, MAHSC, Fac Biol Med & Hlth, Sch Hlth Sci,Div Informat Imaging & Data Sci, Manchester M13 9PL, Lancs, England

[6] Univ Liverpool, Inst Populat Hlth Sci, Dept Publ Hlth & Policy, Liverpool L69 3BX, Merseyside, England

[7] Keele Univ, Fac Med & Hlth Sci, Res Inst Primary Care & Hlth Sci, DJW 1-54a, Keele ST5 5BJ, Staffs, England

[8] Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Oxford OX2 6GG, England

[9] Univ Sussex, Brighton & Sussex Med Sch, Div Primary Care & Publ Hlth, Brighton BN1 9PH, E Sussex, England

[10] Univ Manchester, MAHSC, NIHR Manchester Biomed Res Ctr, Manchester M13 9PL, Lancs, England

[11] Univ Manchester, Fac Biol Med & Hlth, Sch Hlth Sci, Ctr Biostat,Div Populat Hlth Hlth Serv Res & Prim, Manchester M13 9PL, Lancs, England

[12] Univ Manchester, Fac Med Biol & Hlth, Div Diabet Endocrinol & Gastroenterol, Manchester M13 9PL, Lancs, England

[13] Manchester Univ NHS Fdn Trust, Manchester Acad Hlth Sci Ctr, Manchester Diabet Ctr, Manchester M13 0JE, Lancs, England

[14] Univ Nottingham, Sch Med, Div Primary Care, Primary Care Stratified Med PRISM, Nottingham NG7 2RD, England

[15] Keele Univ, Inst Primary Care & Hlth Sci, Ctr Prognosis Res, Keele Cardiovasc Res Grp, Stoke On Trent ST4 7QB, Staffs, England

来源：

BMC MEDICINE | 2019年 / 17卷 / 1期

关键词：

Comorbidity; Type 2 diabetes mellitus; CPRD; Prevalence; Primary care; DEPRESSION; PREVALENCE; IMPACT; RISK; ASSOCIATION; MORTALITY; SYMPTOMS; DISEASE; ASTHMA; UK;

D O I：

10.1186/s12916-019-1373-y

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundThe 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.MethodsWe 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.ResultsMore 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.ConclusionsComorbidities 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.

引用

页数：10

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