The Effect of Comorbidity on Glycemic Control and Systolic Blood Pressure in Type 2 Diabetes: A Cohort Study with 5 Year Follow-Up in Primary Care

Abstract

AimsTo explore the longitudinal effect of chronic comorbid diseases on glycemic control (HbA1C) and systolic blood pressure (SBP) in type 2 diabetes patients.MethodsIn a representative primary care cohort of patients with newly diagnosed type 2 diabetes in The Netherlands (n = 610), we tested differences in the five year trend of HbA1C and SBP according to comorbidity profiles. In a mixed model analysis technique we corrected for relevant covariates. Influence of comorbidity (a chronic disease already present when diabetes was diagnosed) was tested as total number of comorbid diseases, and as presence of specific disease groups, i.e. cardiovascular, mental, and musculoskeletal disease, malignancies, and COPD. In subgroup effect analyses we tested if potential differences were modified by age, sex, socioeconomic status, and BMI.ResultsThe number of comorbid diseases significantly influenced the SBP trend, with highest values after five years for diabetes patients without comorbidity (p = 0.005). The number of diseases did not influence the HbA1C trend (p = 0.075). Comorbid musculoskeletal disease resulted in lower HbA1C at the time of diabetes diagnosis, but in higher values after five years (p = 0.044). Patients with cardiovascular diseases had sustained elevated levels of SBP (p = 0.014). Effect modification by socioeconomic status was observed in some comorbidity subgroups.ConclusionsPresence of comorbidity in type 2 diabetes patients affected the long-term course of HbA1C and SBP in this primary care cohort. Numbers and types of comorbidity showed differential effects: not the simple sum of diseases, but specific types of comorbid disease had a negative influence on long-term diabetes control parameters. The complex interactions between comorbidity, diabetes control and effect modifiers require further investigation and may help to personalize treatment goals.

Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco

“…Although the literature indicates this association between glycemic control and healthy lifestyle, a positive statistical relationship between the variables of this context and glycemic control was not found, and was a result also observed in other studies developed in the PHC (19) . The BMI variable was inversely related to glycemic control, unlike that found in other studies (5,9,20) . The most likely explanation for this result is the understanding of the causal relationship between the explanatory variable and the outcome variable: adequate glycemic control can cause weight gain instead of weight gain improving glycemic control (21)(22) .…”

“…Among the measurements for evaluating glycemic control, glycosylated hemoglobin A (hemoglobin A1c) stands out as being considered the standard for long-term evaluation of glycemic control (4) . As important as the data on glycemic control are the factors that can potentially influence them, so that knowledge of these aspects allows health interventions to be adapted, possibly resulting in the improved clinical condition of people with DM (5) . Few studies on this aspect are available in Brazil, and to the authors' knowledge, none have been carried out on a representative sample of people with diabetes in primary care.…”

Identifying Treatment Effect Modifiers in the STarT Back Trial: A Secondary Analysis

“…This finding is consistent with previous studies that have reported treatment effect modification by SES for other health conditions. 48 Weaker evidence for treatment effect modification was found for education and number of pain medications, which although consistent with previous findings, require further exploration in adequately powered studies.…”

Association between Hyperglycemia, C-Reactive Protein and Other Risk Factors in Patients at Cardiovascular Risk

“…Also associated is the Metabolic Syndrome (MS) that includes a number of risk factors that play important role in high morbidity. The obesity, mainly the visceral adipose tissue, is related to the CVD due to the release of inflammatory mediators such as tumor necrosis factor α (TNF-α), interleukin-1 (IL-1), IL-6, resist in and inhibitor of plasminogen activator-1 (PAI-1) leading to a low intensity inflammatory process and resulting in a local immune response and production of pro-inflammatory markers as C reactive protein (CRP) [7]- [11].…”