medwireNews: Cardiovascular diseases predominantly have the largest relative impact on mortality risk for UK people with type 2 diabetes, but other, unrelated conditions have a greater impact in people from Taiwan, research shows.
“This highlights the need for further research to consider the importance of ethnic differences when considering the implications of multimorbidity in people with [type 2 diabetes],” write the researchers in PLOS Medicine.
“It also underscores the importance of personalised care that takes account of individual characteristics, including ethnicity, along with number and type of conditions when managing those with [type 2 diabetes] living with multimorbidity.”
Jason Chiang (University of Melbourne, Australia) and colleagues studied 20,569 people with type 2 diabetes identified in the UK Biobank and 59,657 from the Taiwan National Diabetes Care Management Program (NDCMP), a respective 90.7% and 78.3% of whom had at least one comorbid condition.
A corresponding 76.1% and 57.2% had at least one concordant condition (ie, related cardiometabolic conditions or diabetes complications), most commonly hypertension, in both cohorts, while 66.9% and 58.0% had discordant conditions, the most frequent of which was “painful conditions excluding diabetic neuropathy.”
As the number of comorbid conditions increased, so did mortality risk, in both cohorts. The effect was strongest for concordant conditions, with the adjusted risk increase rising to 5.83-fold for four versus no conditions in the Biobank cohort and to 3.79-fold in the NDCMP. Discordant conditions also had a significant effect, at risk increases of 3.50- and 2.62-fold in the Biobank and NDCMP cohorts, respectively.
Chiang et al note that for any given level of comorbidity, whether concordant or discordant, people from the Taiwanese cohort were at a higher probability of dying than people from the UK Biobank.
The researchers then looked at the relative impact of combinations of comorbidities, regardless of whether they were concordant or discordant, on mortality risk. They found the top three combinations among UK Biobank participants to be coronary heart disease with heart failure, coronary heart disease with chronic kidney disease, and heart failure with dyspepsia; all these combinations raised people’s mortality risk more than fourfold relative to no comorbidity.
Dyspepsia was in fact the only discordant condition to feature within the top five most impactful combinations for the UK cohort.
But the results were strikingly different for the NDCMP cohort, with the top three combinations being painful conditions and alcohol problems, dyspepsia and alcohol problems, and cancer and chronic liver disease, which raised mortality risk 3.65- to 4.02-fold. The only concordant condition to appear within the top five combinations was heart failure.
“It will be important for clinicians to better understand the biology or healthcare delivery approaches that are contributing to these associations in order to tailor advice to better meet the needs of these diverse and complex populations of people with [type 2 diabetes] from different ethnic backgrounds,” the team concludes.
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