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17-07-2020 | Diabetes | News | Article

Nonvascular comorbidities highlighted in type 2 diabetes

Author: Eleanor McDermid

medwireNews: A large study of data from people with type 2 diabetes in general practice reveals that non-cardiovascular (CVD) comorbidities such as osteoarthritis and depression are common, and significantly more so than in people without diabetes.

“Defining patterns of multimorbidity can have important clinical applications such as identifying potentially harmful drug–disease interactions, establishing optimal targeting of specific therapies, and implementing individualised management plans around the time of diagnosis,” say the researchers.

Salwa Zghebi (University of Manchester, UK) and co-researchers examined patient data from 391 English general practices in the Clinical Practice Research Datalink for 18 physical and mental health morbidities. They found that 76.7% of 108,588 people with type 2 diabetes had at least one of these comorbidities, compared with 54.2% of 528,667 controls without diabetes who were matched for age, gender and general practice.

As expected, CVD was highly prevalent – with hypertension being the most common condition in both groups – and was significantly more common among people with diabetes than controls. In particular, they had a more than twofold increased likelihood of having hypertension, myocardial infarction, heart failure, and peripheral vascular disease.

But the team also identified a number of non-CVD conditions with a high prevalence in people with diabetes, namely osteoarthritis (18.4%), depression (12.4%), asthma (8.5%), hypothyroidism (6.7%), chronic obstructive pulmonary disease (5.9%), and anxiety (5.6%).

All of these conditions were significantly more likely to occur in people with diabetes than those without, but the researchers also highlight schizophrenia, which although one of the least common conditions overall, was 2.38-fold more likely to occur among people with diabetes than the controls.

“[P]rior research has mainly focused on patterns of cardiovascular disease in people with [type 2 diabetes] resulting in little understanding of trends of a broader range of important comorbidities in people with and without [type 2 diabetes],” write the researchers in BMJ Open.

They add that non-CVD comorbidities rarely feature in guidelines for type 2 diabetes management.

Among people with type 2 diabetes, comorbidities overall were more common in women than men, with hypothyroidism in particular being around four times higher.

Comorbidity prevalence increased with older age in people with diabetes but remained higher than in controls in all age groups. The exceptions were asthma and anxiety, which remained stable across age groups, and depression, which was more common in people aged 55 years or younger than in older people.

Stressing that depression was a common finding overall, the team says this “highlights a profound clinical need in young people who could benefit enormously from mental health intervention.”

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BMJ Open 2020; 10: e033866