Department of General Practice, University of Melbourne, Melbourne, Australia.
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
PLoS One. 2018 Dec 26;13(12):e0209585. doi: 10.1371/journal.pone.0209585. eCollection 2018.
Type 2 diabetes (T2D) is a major health priority worldwide and the majority of people with diabetes live with multimorbidity (MM) (the co-occurrence of ≥2 chronic conditions). The aim of this systematic review was to explore the association between MM and all-cause mortality and glycaemic outcomes in people with T2D.
The search strategy centred on: T2D, MM, comorbidity, mortality and glycaemia. Databases searched: MEDLINE, EMBASE, CINAHL Complete, The Cochrane Library, and SCOPUS. Restrictions included: English language, quantitative empirical studies. Two reviewers independently carried out: abstract and full text screening, data extraction, and quality appraisal. Disagreements adjudicated by a third reviewer.
Of the 4882 papers identified; 41 met inclusion criteria. The outcome was all-cause mortality in 16 studies, glycaemia in 24 studies and both outcomes in one study. There were 28 longitudinal cohort studies and 13 cross-sectional studies, with the number of participants ranging from 96-892,223. Included studies were conducted in high or upper-middle-income countries. Fifteen of 17 studies showed a statistically significant association between increasing MM and higher mortality. Ten of 14 studies showed no significant associations between MM and HbA1c. Four of 14 studies found higher levels of MM associated with higher HbA1c. Increasing MM was significantly associated with hypoglycaemia in 9/10 studies. There was no significant association between MM and fasting glucose (one study). No studies explored effects on glycaemic variability.
This review demonstrates that MM in T2D is associated with higher mortality and hypoglycaemia, whilst evidence regarding the association with other measures of glycaemic control is mixed. The current single disease focused approach to management of T2D seems inappropriate. Our findings highlight the need for clinical guidelines to support a holistic approach to the complex care needs of those with T2D and MM, accounting for the various conditions that people with T2D may be living with.
International Prospective Register of Systematic Reviews CRD42017079500.
2 型糖尿病（T2D）是全球的一个主要健康重点，大多数糖尿病患者患有多种合并症（MM）（≥2 种慢性疾病同时存在）。本系统综述的目的是探讨 T2D 患者的 MM 与全因死亡率和血糖控制结果之间的关联。
搜索策略集中在：T2D、MM、合并症、死亡率和血糖。搜索的数据库包括：MEDLINE、EMBASE、CINAHL Complete、Cochrane 图书馆和 SCOPUS。限制条件包括：英语语言，定量实证研究。两位审稿人独立进行：摘要和全文筛选、数据提取和质量评估。有分歧的由第三位审稿人裁决。
在 4882 篇论文中，有 41 篇符合纳入标准。16 项研究的结局为全因死亡率，24 项研究的结局为血糖，1 项研究的结局为两者。其中包括 28 项纵向队列研究和 13 项横断面研究，参与者人数从 96 到 892223 不等。纳入的研究均在高收入或中上收入国家进行。17 项研究中有 15 项显示 MM 增加与死亡率升高存在统计学显著关联。14 项研究中有 10 项显示 MM 与 HbA1c 之间无显著关联。14 项研究中有 4 项发现 MM 水平升高与 HbA1c 升高相关。9/10 项研究显示，MM 增加与低血糖显著相关。一项研究显示 MM 与空腹血糖无显著关联。没有研究探讨 MM 对血糖变异性的影响。
本综述表明，T2D 中的 MM 与死亡率升高和低血糖相关，而关于与其他血糖控制措施的关联的证据则相互混杂。目前针对 T2D 的单一疾病治疗方法似乎并不合适。我们的研究结果强调了临床指南需要支持一种综合方法来满足 T2D 和 MM 患者的复杂护理需求，同时考虑到 T2D 患者可能同时存在的各种疾病。
国际前瞻性系统评价注册库 CRD42017079500。
