Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice

Abstract

ObjectivesTo 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).DesignCross-sectional study.SettingAustralian general practice.Participants69 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).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (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.ConclusionsMultimorbidity 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.

Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study

“…In the current study, almost all the T2D patients had one or more diseases in addition to T2D. This is in line with the prevalence rate reported among Australian primary care patients (90 %; [ 7 ]), but slightly higher than the rates among English (77 %; [ 8 ]), Croatian (78 %; [ 28 ]) and Danish patients (80 %; [ 29 ]). We found no studies assessing the frequency of multimorbidity by evaluating several diseases among Scandinavian patients with T2D other than that of Pouplier et al [ 29 ].…”

“…Most of our patients had diagnoses of both concordant and discordant diseases, and having only concordant disease(s) was more common than having only discordant disease(s). Findings have been published that are both similar [ 19 ] and contradictory [ 7 , 30 ].…”

“…Classification of long-term diseases as concordant and discordant diseases is presented in Table 1 . Concordant diseases, which are thought to share a similar pathophysiology with T2D, were selected in line with earlier publications [ 7 , 18 ]. To study cardiovascular diseases in general, we combined coronary heart disease, peripheral vascular disease, and stroke/TIA with cardiovascular diseases.…”

“…T2D rarely occurs without coexisting diseases. It has been reported that 77–90 % of patients with T2D also have one or more other diseases and can therefore be categorised as multimorbid [ 7 , 8 ]. Typical diseases that coexist with T2D are hypertension and cardiovascular diseases [ 8 , 9 ], but different pains and mental health problems are also prevalent [ 7 – 9 ].…”

“…It has been reported that 77–90 % of patients with T2D also have one or more other diseases and can therefore be categorised as multimorbid [ 7 , 8 ]. Typical diseases that coexist with T2D are hypertension and cardiovascular diseases [ 8 , 9 ], but different pains and mental health problems are also prevalent [ 7 – 9 ]. The presence of coexisting diseases associates with patients’ unbeneficial self-care behaviours [ 10 ], macrovascular complications, hospitalisation, and mortality among patients with T2D [ 11 , 12 ].…”