NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.
Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.
BMC Med. 2019 Jul 25;17(1):145. doi: 10.1186/s12916-019-1373-y.
The 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.
We 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.
More 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.
Comorbidities 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.
患有额外的慢性疾病会对 2 型糖尿病（T2DM）的治疗和管理产生重大影响。对于该人群的合并症模式知之甚少。本研究的目的是量化 T2DM 患者的合并症模式，估计 2027 年六种慢性疾病的患病率，并确定相似疾病的聚类。
我们使用临床实践研究数据链接（CPRD）与贫困指数（IMD）数据相结合，以确定 2007 年至 2017 年间被诊断患有 T2DM 的患者。共有 102394 人符合研究纳入标准。我们计算了在 T2DM 诊断时和之后出现的 18 种慢性疾病的粗患病率和年龄标准化患病率。我们对 6 种最常见的疾病进行了纵向分析，并使用线性回归预测了 2027 年的患病率。我们使用凝聚层次聚类来识别合并症聚类。这些分析在按性别和贫困程度分层的亚组中重复进行。
与最富裕地区（女性为 67%；男性为 59%）相比，生活在最贫困地区的人在诊断时（女性 72%；男性 64%）有更多的人患有≥1 种合并症。所有人群中抑郁症的患病率都有所增加，在最贫困地区更为常见。预计 2027 年，33%的女性和 15%的男性被诊断为 T2DM 的患者会患有抑郁症。观察到中度聚类趋势，一致的情况分组在一起，不同人群之间的组存在一些差异。
在该人群中，合并症很常见，患者之间合并症模式的高度变异性强调了以患者为中心的医疗保健的必要性。精神健康是一个日益严重的问题，需要针对该人群的身心健康采取干预措施。
