Nearly 98% of American adults with type 2 diabetes have at least one comorbid condition and nearly 90% have two comorbidities, with the burden increasing with age and more prevalent in men, recent study findings show.
“Management of patients with type 2 diabetes is complicated by the fact that diabetes does not often occur in isolation,” Swapnil N. Rajpathak, MD, MPH, DrPH, executive director of the Center of Observational and Real-world Evidence (CORE), Merck, told Endocrine Today. “A diagnosis of diabetes is often accompanied by additional diagnoses of other comorbid conditions, each with their own risks and challenges, which can impact a patient’s overall disease state. Understanding the degree to which comorbidities occur, and which comorbid conditions commonly co-occur in patients with diabetes, is critical to comprehensively manage these patients, including the selection of treatment for type 2 diabetes.”
Swapnil N. Rajpathak
In a retrospective analysis of electronic health records, Rajpathak and colleagues reviewed a cohort of adult patients with type 2 diabetes and at least one encounter in the database and at least 1 year of medical history available from July 2014 to June 2015 (n = 1,389,016; 53% women; mean age, 65 years; mean HbA1c, 6.8%). Researchers assessed comorbid conditions using all data available before and including the index date. Within the cohort, 97.5% of patients had at least one comorbid condition; 88.5% had at least two.
Researchers found the most common comorbid conditions were hypertension (82.1%), overweight or obesity (78.2%), hyperlipidemia (77.2%), chronic kidney disease (24.1%) and cardiovascular disease (21.6%). Researchers also found that the most prevalent comorbid co-conditions were hypertension plus hyperlipidemia (67.5%), followed by overweight or obesity plus hypertension (66%), overweight or obesity plus hyperlipidemia (62.5%), hypertension plus CKD (22.4%), hyperlipidemia plus CKD (21.1%), hypertension plus CVD (20.2%), hyperlipidemia plus CVD (20.1%), overweight or obesity plus CKD (19.1%), and overweight or obesity plus CVD (17%).
Individual comorbidities and co-prevalence of comorbidities increased with age. For example, researchers found a sixfold increase in the co-prevalence of CVD and CKD from the youngest to oldest age groups (younger than 65 years, 3%; aged 65-74 years, 9.8%; at least age 75 years, 18.5%).
“Given the extent of multimorbidity in patients with type 2 diabetes, it is important to take a comprehensive approach to patient management and continually assess the presence of comorbidity in clinical practice,” Rajpathak said. “This is consistent with the American Diabetes Association (ADA) guidelines, which recommend evaluating comorbidities as part of an initial assessment in these patients.”
Rajpathak said future studies should evaluate how physicians currently take into account multimorbidity when managing patients with diabetes, and how treatment approaches that account for existing comorbidities in addition to glycemic status may yield better short-term and long-term clinical outcomes among patients with diabetes. – by Regina Schaffer
For more information:
Swapnil N. Rajpathak, MD, MPH, DrPH, can be reached at 600 Corporate Drive, Lebanon , NJ 08833; email: email@example.com.
Merck & Co. funded this study. All study researchers were employees of Merck at the time of this analysis and may hold stock in the company.