medwireNews: Only two of the five most common comorbidities identified in a UK population with type 2 diabetes are traditionally associated with the condition, say researchers.
The most common comorbidity at the point of diabetes diagnosis was hypertension, with an age-standardized prevalence of 36.8%. Although ischemic heart disease was also frequent, its prevalence of 10.2% made it only the fifth most common condition.
The other three of the top five conditions were back pain, depression, and osteoarthritis, present in 25.3%, 15.3%, and 11.1% of the study participants, respectively.
These comorbidities were recorded in the records of 224,000 people (about 45% women, average age approximately 60 years) with type 2 diabetes identified in the UK Discover-Now primary care dataset between 2000 and 2020.
At diagnosis, about 55% of the study participants had one or no comorbidity but 10 years later this was the case for only 20%, whereas the proportion with five or more comorbidities rose from about 5% to 25%. During this time, the age-standardized prevalence of retinopathy rose from 4.8% to 41.3%, making it the third most common comorbidity at year 10.
Jonathan Pearson-Stuttard (Health Analytics, Lane Clark & Peacock LLP, London, UK) and co-researchers highlight the difference in comorbidity profiles between people who did and did not have obesity at diagnosis, with the former having a marked increase in the rate of nonvascular comorbidities versus the latter.
Among people with obesity, hypertension remained the most common comorbidity, with the remainder of the top five comorbidities comprising back pain, depression, osteoarthritis, and asthma.
Deprived and affluent people had a “surprisingly similar” prevalence of comorbidities, report the researchers in eClinicalMedicine, although deprived people had increased rates of some less common conditions, such as severe mental illness and chronic obstructive pulmonary disease.
By contrast, there were “larger differences” in the type and prevalence of the most common comorbidities between different ethnicities “reflecting further the vast differences in unmet health need across people with [type 2 diabetes],” the team adds.
For example, White people had a twofold higher prevalence of depression than Asian people, Asian people had a twofold increased prevalence of hypothyroidism compared with Black people, and Black people had increased rates of severe mental illness, cancer, stroke, and chronic kidney disease relative to Asian people.
The majority (41–47%) of the study population were Asian or British Asian, with about 30% being White, and about 11% Black or Black British.
“There are currently few care pathways or guidelines that capture both the breadth and comprehensive nature of the comorbidities faced by those with [type 2 diabetes] while cognisant of how unique this is for each patient sub-group,” write the researchers.
They hope their findings can “inform the development of more holistic, comorbidity based clinical guidelines” for people with type 2 diabetes, which could “benefit patients, reduce inequalities in morbidity in this patient group and reduce acute demand on healthcare systems.”
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