The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data

Abstract

Background Achieving an optimal glycemic control has been described to reduce the incidence of diabetes mellitus (DM) related complications. The association between comorbidities and glycemic control remains unclear. Our aim is to evaluate the effect of comorbidities on glycemic control in people living with DM. Methods A retrospective longitudinal study on data from the National Registry of Chronic Kidney Disease from 2014 to 2019 in Colombia. The outcome was poor glycemic control (PGC = HbA1c ≥7.0%). The association between each comorbidity (hypertension (HTN), chronic kidney disease (CKD) or obesity) and PGC was evaluated through multivariate mixed effects logistic regression models. The measures of effect were odds ratios (OR) and their 95% confidence intervals (CI). We also evaluated the main associations stratified by gender, insurance, and early onset diabetes as well as statistical interaction between each comorbidity and ethnicity. Results From 969,531 people at baseline, 85% had at least one comorbidity; they were older and mostly female. In people living with DM and CKD, the odds of having a PGC were 78% (OR: 1.78, CI 95%: 1.55-2.05) higher than those without CKD. Same pattern was observed in obese for whom the odds were 52% (OR: 1.52, CI 95%: 1.31-1.75) higher than in non-obese. Non-significant association was found between HTN and PGC. We found statistical interaction between comorbidities and ethnicity (afro descendant) as well as effect modification by health insurance and early onset DM. Conclusions Prevalence of comorbidities was high in adults living with DM. Patients with concomitant CKD or obesity had significantly higher odds of having a PGC.

Determinants of poor glycemic control among type 2 diabetes mellitus patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched case-control study

“…Patients who have one or more comorbidities have higher odds of having poor glycemic control, a result similar to what is reported in previous studies in Ethiopia ( 10 , 45 , 51 ). Similarly, a study conducted in Iran ( 52 ), Colombia ( 53 ), and North America ( 54 ) showed that type 2 diabetes mellitus patients who had comorbidities had a higher chance of poor glycemic control than those who didn’t have complications. The reason for respondents with comorbidities having poor glycemic control might be due to poor adherence to medication because of additional medication pill burden.…”

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

“…With a longer duration of diabetes, there is a deterioration of the function of the pancreas due to failure in beta cells, and the emergence of disease-related complications, which in turn can have effects on glycaemic control [8,111]. The presence of comorbidities/complications poses a problem with respect to pill burden, adherence to treatment and cost, or as an intricate mechanism linked to beta-cell impairment or aggravation of insulin resistance [8,94,[112][113][114][115][116][117]. In sub-Saharan Africa, there is a high proportion of undiagnosed diabetes mellitus, and the diagnosis is often delayed.…”

Admission Blood Glucose Level as a Predictor of Outcome in Intensive Care Patients: A Cross-Sectional Study

“…Another study stated that having diabetes and CKD or obesity increased the likelihood of developing poor glycemic control and elevated blood glucose level, in contrast to not having these concomitant conditions. Hypertension, however, was shown to have no connection with elevated blood glucose levels [ 22 ]. Similarly, a link between obesity and inadequate glycemic control was discovered in a cross-sectional study of the Iranian population with diabetes [ 23 ].…”