PITCH: Mapping the patterns of multimorbidity burden of type-2 diabetes mellitus: cohort study using the UK Clinical Practice Research Datalink

Conference:

SAPC ASM 2018 - London

Talk Code:

5E.3b

Presenter:

Magdalena Nowakowska

Co-authors:

Salwa S M Zghebi‎, Evangelos Kontopantelis

Author institutions:

NIHR School for Primary Care Research; University of Manchester; Manchester; UK, Division of Population Health, Health Services Research & Primary Care; University of Manchester; Manchester; UK

Problem

The comorbidity burden of people with type-2 diabetes (T2DM) is important in the management of the condition, with most people with T2DM having at least one other physical comorbidity. The presence of comorbidities in T2DM patients can influence multiple aspects of the disease progression and management, especially if the concordant-discordant model is considered. This study aimed to estimate the prevalence and co-prevalence of 16 chronic conditions in people with T2DM in the UK.

Approach

Using the Clinical Practice Research Datalink (CPRD) database, we identified 201,364 patients diagnosed with T2DM between 2006 and 2016. We used descriptive statistics to identify patterns of prevalence and co-prevalence of 16 comorbidities (coronary heart disease (CHD), chronic kidney disease (CKD), atrial fibrillation, dementia, stroke, asthma, osteoporosis, osteoarthritis, depression, COPD, cancer, hypertension, severe mental illness and hypothyroidism) and the total number of comorbidities present at the time of T2DM diagnosis and during a 11-year follow up period. We analysed the prevalence of each condition longitudinally and used linear regression to forecast the prevalence of selected conditions for 2020 and 2030. All analyses were stratified by gender, age and deprivation.

Findings

At the time of the T2DM diagnosis, over 73.3% of patients with T2DM (79.2% of females; 68.7% of males) had at least one comorbidity (41.4% ≤ 2 and 19.9% ≤ 3) with females having on average (mean±SD) higher count of comorbidity (1.73±1.44) than males (1.28±1.25). Hypertension was the most common condition amongst males and females, followed by osteoarthritis and depression in females and CHD in males. For females, the most common pairs of comorbidities were osteoarthritis and hypertension (16.53%), depression and hypertension (10.39%) and hypertension and CKD (8.41%) whereas for males it was hypertension and osteoarthritis (9.51%), hypertension and CHD (8.75%) and depression and hypertension (5.21%). Between 2006 and 2016, the proportion of people with depression increased in all age groups. This pattern was predicted to continue with around 35% of people under 75 years old estimated to have depression at the time of T2DM diagnosis by 2030. Females developed more conditions after the diagnosis (0.66±0.90 for females; 0.56±0.82 for males). The most common pair of conditions developed after the T2DM diagnosis was hypertension and depression (4.92% of females; 3.63% of males).

Consequences

The majority of T2DM patients in the UK live with at least one other chronic condition. Patterns of comorbidity differed across population strata, highlighting different treatment and management needs, especially considering the high co-prevalence of discordant conditions such as hypertension and depression. Clinical guidelines need to prioritise accounting for multimorbidity in the management of T2DM, and ideally varying across population strata.

Submitted by:

Magdalena Nowakowska

Funding acknowledgement:

This study is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR), grant number 331. This report is independent research by the National Institute for Health Research. The views expressed in this publication are those of the authors and necessarily those of the NHS, the National Institute for Health Research or the Department of Health.