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

Abstract

Background Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). Methods The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. Results Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72). Conclusions Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.

Association of renal function screening frequency with renal function decline in patients with type 2 diabetes: a real-world study in primary health care

“…The preferred source of BP data was the patients’ own home measurements. If home measurements were not available, the measurements performed by a healthcare professional during the consultation visit were used [ 20 , 21 ].…”

Association of musculoskeletal pain with the achievement of treatment targets for type 2 diabetes among primary care patients

“…Data on other chronic diseases were collected between 2011 and 2019. Of ICD-10-based chronic diseases, diseases of which pathophysiology are related to T2D (hypertension, hyperlipidemia, atrial fibrillation, heart failure, obesity, chronic kidney disease, and cardiovascular diseases) and those non-T2D-related diseases whose prevalence rate was 5% or over in the present study population (cancer, asthma/chronic obstructive pulmonary disease, hyperplasia of prostate, hypothyroidism, dementia/Alzheimer's disease, depression, and sleep disorders), were selected, as presented in our previous study [6]. In this study, we also included alcohol-related disorders in the latter category to evaluate alcohol as a potential covariate.…”

“…In this study, we also included alcohol-related disorders in the latter category to evaluate alcohol as a potential covariate. Then, multimorbidity was grouped as: concordant (T2D-related), discordant (non-T2D-related), concordant and discordant, and no multimorbidity, as T2D-related and non-T2D-related diseases are differently associated with meeting the T2D treatment targets [6]. Weight and height were either based on self-reports or measured performed during T2D consultation visits and were converted into BMI (kg/m 2 ).…”

“…Type 2 diabetes (T2D) is a prevalent condition causing a significant cost and disability burden for those affected, and for societies worldwide [1,2]. It appears to co-exist with other long-term diseases [3][4][5][6] and show high prevalence, especially among those of working age and older adults [7]. T2D is known to be driven by both genetic and environmental/behavioural factors including unhealthy behaviours, such as physical inactivity and obesity [8,9].…”

“…Musculoskeletal (MS) pain is among the most common co-existing diseases among patients with T2D [3][4][5][6] and significantly associated with T2D [18][19][20][21]. MS pain has been shown to have a negative influence on activity limitations and on the odds of disability [22,23], and be negatively associated with self-care behaviours, such as physical activity levels [24] and medication adherence [25].…”