The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort
Magdalena Nowakowska,
Salwa S. Zghebi,
Darren M. Ashcroft,
Iain Buchan,
Carolyn Chew-Graham,
Tim Holt,
Christian Mallen,
Harm Van Marwijk,
Niels Peek,
Rafael Perera-Salazar,
David Reeves,
Martin K. Rutter,
Stephen F. Weng,
Nadeem Qureshi,
Mamas A. Mamas,
Evangelos Kontopantelis
Affiliations
Magdalena Nowakowska
NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester
Salwa S. Zghebi
NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester
Darren M. Ashcroft
NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester
Iain Buchan
Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester
Carolyn Chew-Graham
Research Institute for Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University
Tim Holt
Nuffield Department of Primary Care Health Sciences, University of Oxford
Christian Mallen
Research Institute for Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University
Harm Van Marwijk
Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex
Niels Peek
NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester
Rafael Perera-Salazar
Nuffield Department of Primary Care Health Sciences, University of Oxford
David Reeves
NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester
Martin K. Rutter
Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medicine, Biology and Health, University of Manchester
Stephen F. Weng
Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of Medicine, University of Nottingham
Nadeem Qureshi
Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of Medicine, University of Nottingham
Mamas A. Mamas
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University
Evangelos Kontopantelis
NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester
Abstract Background The presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions. Methods We used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation. Results More people living in the most deprived areas had ≥ 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics. Conclusions Comorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.
