Pearson-Stuttard Jonathan, Holloway Sara, Polya Rosie, Sloan Rebecca, Zhang Linxuan, Gregg Edward W, Harrison Katy, Elvidge Jamie, Jonsson Pall, Porter Thomas
Health Analytics, Lane Clark & Peacock LLP, London, UK.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
EClinicalMedicine. 2022 Aug 1;52:101584. doi: 10.1016/j.eclinm.2022.101584. eCollection 2022 Oct.
The prevalence of type 2 diabetes (T2DM) is increasing, but increasing longevity among persons with diagnosed diabetes may be is associated with more extensive and diverse types of morbidity. The extent and breadth of morbidity and how this varies across sub-groups is unclear and could have important clinical and public health implications. We aimed to estimate comorbidity profiles in people with T2DM and variations across sub-groups and over time.
We identified approximately 224,000 people with T2DM in the Discover-NOW dataset, a real-world primary care database from 2000 to 2020 covering 2.5 million people across North-West London, England, linked to hospital records. We generated a mixed prevalence and incidence study population through repeated annual cross sections, and included a broad set of 35 comorbidities covering traditional T2DM conditions, emerging T2DM conditions and other common conditions.We estimated annual age-standardised prevalence of comorbidities, over the course of the disease in people with T2DM and several sub-groups.
Multimorbidity (two or more chronic conditions) is common in people with T2DM and increasing, but the comorbidity profiles of people with T2DM vary substantially. Nearly 30% of T2DM patients had three or more comorbidities at diagnosis, increasing to 60% of patients ten years later. Two of the five commonest comorbidities at diagnosis were traditional T2DM conditions (hypertension (37%) and ischaemic heart disease (10%)) the other three were not (depression (15%), back pain (25%) and osteoarthritis (11%)). The prevalence of each increased during the course of the disease, with more than one in three patients having back pain and one in four having depression ten years post diagnosis.People with five or more comorbidities at diagnosis had higher prevalence of each of the 35 comorbidities. Hypertension (73%) was the commonest comorbidity at diagnosis in this group; followed by back pain (69%), depression (67%), asthma (45%) and osteoarthritis (36%). People with obesity at diagnosis had substantially different comorbidity profiles to those without, and the five commonest comorbidities were 50% more common in this group.
Preventative and clinical interventions alongside care pathways for people with T2DM should transition to reflect the diverse set of causes driving persistent morbidity. This would benefit both patients and healthcare systems alike.
The study was funded by the National Institute for Health and Care Excellence (NICE).
2型糖尿病（T2DM）的患病率正在上升，但确诊糖尿病患者的寿命延长可能与更广泛、更多样化的发病类型有关。发病的程度和范围以及不同亚组之间的差异尚不清楚，这可能对临床和公共卫生具有重要意义。我们旨在评估T2DM患者的合并症情况、亚组间差异以及随时间的变化。
我们在“发现 - 现在”数据集中识别出约22.4万名T2DM患者，该数据集是一个2000年至2020年的真实世界初级保健数据库，覆盖英格兰伦敦西北部的250万人，并与医院记录相关联。我们通过重复的年度横断面生成了一个混合患病率和发病率研究人群，并纳入了涵盖传统T2DM病症、新兴T2DM病症和其他常见病症的35种广泛合并症。我们估计了T2DM患者及其几个亚组在疾病过程中合并症的年度年龄标准化患病率。
多重疾病（两种或更多慢性疾病）在T2DM患者中很常见且呈上升趋势，但T2DM患者的合并症情况差异很大。近30%的T2DM患者在诊断时有三种或更多合并症，十年后这一比例增至60%。诊断时最常见的五种合并症中有两种是传统T2DM病症（高血压（37%）和缺血性心脏病（10%）），另外三种不是（抑郁症（15%）、背痛（25%）和骨关节炎（11%））。每种合并症的患病率在疾病过程中都有所增加，诊断后十年，超过三分之一的患者有背痛，四分之一的患者有抑郁症。诊断时患有五种或更多合并症的患者，35种合并症中的每种患病率都更高。高血压（73%）是该组诊断时最常见的合并症；其次是背痛（69%）、抑郁症（67%）、哮喘（45%）和骨关节炎（36%）。诊断时肥胖的患者与非肥胖患者的合并症情况有很大不同，该组中最常见的五种合并症比非肥胖组常见50%。
针对T2DM患者的预防和临床干预以及护理途径应进行转变，以反映导致持续发病的各种不同原因。这将使患者和医疗系统都受益。
该研究由英国国家卫生与临床优化研究所（NICE）资助。
