Chiang Jason I, Furler John, Mair Frances, Jani Bhautesh D, Nicholl Barbara I, Thuraisingam Sharmala, Manski-Nankervis Jo-Anne
Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Victoria, Australia
Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open. 2020 Nov 26;10(11):e039625. doi: 10.1136/bmjopen-2020-039625.
To explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).
Cross-sectional study.
Australian general practice.
69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).
Prevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).
Mean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.
Multimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.
利用电子健康记录（EHR）数据，探究在澳大利亚普通诊所就诊的2型糖尿病（T2D）患者中，多种疾病共存的患病率以及长期病症（LTCs）的个体情况和合并情况。我们还研究了多种疾病共存情况的计数（总计/一致（与T2D相关）/不一致（不相关））与血糖（糖化血红蛋白，HbA1c）之间的关联。
横断面研究。
澳大利亚普通诊所。
MedicineInsight数据库中记录的2013年至2015年间在普通诊所就诊的69718例T2D患者（来自557家普通诊所和超过380万澳大利亚患者的EHR数据）。
多种疾病共存的患病率、LTCs的个体情况和合并情况。使用多变量线性回归模型研究多种疾病共存计数与HbA1c（%）之间的关联。
平均（标准差）年龄66.42（12.70）岁，46.1%为女性，平均（标准差）HbA1c为7.1（1.4）%。超过90%的T2D患者患有多种疾病。不一致的病症比一致的病症更常见（83.4%对69.9%）。三种最常见的不一致病症为：疼痛性病症（55.4%）、消化不良（31.6%）和抑郁症（22.8%）。三种最常见的一致病症为：高血压（61.4%）、冠心病（17.1%）和慢性肾病（8.5%）。三种最常见的病症组合为：疼痛性病症和高血压（38.8%）、疼痛性病症和消化不良（23.1%）以及高血压和消化不良（22.7%）。我们发现任何多种疾病共存计数（总计、一致和不一致）或组合与HbA1c之间均无关联。
在我们这组就诊于澳大利亚普通诊所的T2D患者中，多种疾病共存情况很常见，但与血糖无关。尽管我们在本研究中未探讨死亡率，但我们的结果表明，其他研究中观察到的多种疾病共存且患有T2D的患者死亡率增加可能与血糖无关。有趣的是，不一致的病症比一致的病症更常见，疼痛性病症是第二常见的合并症。更好地了解T2D患者中不同多种疾病共存模式的影响将有助于提供更有效的个性化护理。
