Multimorbidity, mortality, and HbA1c in type 2 diabetes: A cohort study with UK and Taiwanese cohorts

Abstract

Background There is emerging interest in multimorbidity in type 2 diabetes (T2D), which can be either concordant (T2D related) or discordant (unrelated), as a way of understanding the burden of disease in T2D. Current diabetes guidelines acknowledge the complex nature of multimorbidity, the management of which should be based on the patient's individual clinical needs and comorbidities. However, although associations between multimorbidity, glycated haemoglobin (HbA1c), and mortality in people with T2D have been studied to some extent, significant gaps remain, particularly regarding different patterns of multimorbidity, including concordant and discordant conditions. This study explores associations between multimorbidity (total condition counts/concordant/discordant/different combinations of conditions), baseline HbA1c, and all-cause mortality in T2D. Methods and findings We studied two longitudinal cohorts of people with T2D using the UK Biobank (n = 20,569) and the Taiwan National Diabetes Care Management Program (NDCMP) (n = 59,657). The number of conditions in addition to T2D was used to quantify total multimorbidity, concordant, and discordant counts, and the effects of different combinations of conditions were also studied. Outcomes of interest were baseline HbA1c and all-cause mortality. For the UK Biobank and Taiwan NDCMP, mean (SD) ages were 60.2 (6.8) years and 60.8 (11.3) years; 7,579 (36.8%) and 31,339 (52.5%) were female; body mass index (BMI) medians (IQR) were 30.8 (27.7, 34.8) kg/m 2 and 25.6 (23.5, 28.7) kg/m 2 ; and 2,197 (10.8%) and 9,423 (15.8) were current smokers, respectively. Increasing total and discordant multimorbidity counts were associated with lower HbA1c and increased mortality in both datasets. In Taiwan NDCMP, for those with four or more additional conditions compared with T2D only, the mean difference (95% CI) in HbA1c was −0.82% (−0.88, −0.76) p < 0.001. In UK Biobank, hazard ratios (HRs) (95% CI) for all-cause mortality in people with T2D and one, two, three,

Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort

“…Future research is needed to corroborate these findings in other countries and in people from different ethnic backgrounds. We know that patterns of multimorbidity differ across ethnic groups and have different associations with mortality, so this merits further investigation [ 40 ]. We also need to explore the implications of different patterns of multimorbidity on COVID-19 related health care outcomes in the short and long term.…”

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

“…30 Our findings contrast with a recent study of diabetes and multimorbidity using data from UK Biobank and the Taiwan National Diabetes Care Management Programme which suggested that increasing total and discordant multimorbidity counts were associated with lower HbA1c and increased mortality in both datasets. 6 Our findings show that coronary heart disease was associated with slightly higher HbA1c both when considered as an individual condition and in different combinations with hypertension, depression, anxiety and psoriasis/eczema. Although the degree of observed differences in HbA1c noted in our study (ranging from Open access Open access 0.03% to 0.08%) and the recent UK and Taiwan study are very small and are not likely to be clinically significant despite being statistically significant.…”

“…4 The prevalence of individual LTCs identified in our study align with a recent study that explored multimorbidity in people with T2D across the UK and Taiwan. 6 This is in spite of the study examining community cohorts of people with T2D rather than people attending general practice. This confirms how commonly people are burdened by multimorbidity and that that this is likely to impact on the already complex nature of T2D management.…”

“…4 Multimorbidity amplifies the complex management of T2D including the challenges in managing higher treatment burden due to complicated self-management requirements as a result of having multiple LTCs 5 and has been associated with increased mortality. 6 Multimorbidity in those with T2D could result in reduced adherence to complex therapeutic regimens Open access and poorer outcomes including suboptimal glycaemic management, [7][8][9] which may underpin poor outcomes. Glycated haemoglobin (HbA1c) is an important clinical measure to consider in T2D and glycaemic management is a key component of clinical guidelines for people with T2D.…”

Decompression of Multimorbidity Along the Disease Trajectories of Diabetes Mellitus Patients

“…Fueled by an aging population, the percentage of people with two or more health conditions is steadily increasing which in turn drives morbidity and mortality (Soh et al, 2020;Whitty et al, 2020). One of the drivers of the rise of multimorbidity is diabetes mellitus (DM) due to its large number of physical and mental risk factors and complications (Chiang et al, 2020). For instance, heart disease and stroke are well-established complications of diabetes whereas overweight, hypertension, or tobacco use are known risk factors for diabetes (Xu et al, 2018).…”