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Jalali-Najafabadi F, Bailey R, Lyons J, Akbari A, Ba Dhafari T, Azadbakht N, Rafferty J, Watkins A, Martin GP, Bowes J, Lyons RA, Barton A, Peek N. 10-year multimorbidity patterns among people with and without rheumatic and musculoskeletal diseases: an observational cohort study using linked electronic health records from Wales, UK. BMJ Open 2024; 14:e079169. [PMID: 38904124 PMCID: PMC11191776 DOI: 10.1136/bmjopen-2023-079169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES To compare the patterns of multimorbidity between people with and without rheumatic and musculoskeletal diseases (RMDs) and to describe how these patterns change by age and sex over time, between 2010 and 2019. PARTICIPANTS 103 426 people with RMDs and 2.9 million comparators registered in 395 Wales general practices (GPs). Each patient with an RMD aged 0-100 years between January 2010 and December 2019 registered in Clinical Practice Research Welsh practices was matched with up to five comparators without an RMD, based on age, gender and GP code. PRIMARY OUTCOME MEASURES The prevalence of 29 Elixhauser-defined comorbidities in people with RMDs and comparators categorised by age, gender and GP practices. Conditional logistic regression models were fitted to calculate differences (OR, 95% CI) in associations with comorbidities between cohorts. RESULTS The most prevalent comorbidities were cardiovascular risk factors, hypertension and diabetes. Having an RMD diagnosis was associated with a significantly higher odds for many conditions including deficiency anaemia (OR 1.39, 95% CI (1.32 to 1.46)), hypothyroidism (OR 1.34, 95% CI (1.19 to 1.50)), pulmonary circulation disorders (OR 1.39, 95% CI 1.12 to 1.73) diabetes (OR 1.17, 95% CI (1.11 to 1.23)) and fluid and electrolyte disorders (OR 1.27, 95% CI (1.17 to 1.38)). RMDs have a higher proportion of multimorbidity (two or more conditions in addition to the RMD) compared with non-RMD group (81% and 73%, respectively in 2019) and the mean number of comorbidities was higher in women from the age of 25 and 50 in men than in non-RMDs group. CONCLUSION People with RMDs are approximately 1.5 times as likely to have multimorbidity as the general population and provide a high-risk group for targeted intervention studies. The individuals with RMDs experience a greater load of coexisting health conditions, which tend to manifest at earlier ages. This phenomenon is particularly pronounced among women. Additionally, there is an under-reporting of comorbidities in individuals with RMDs.
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Affiliation(s)
- Farideh Jalali-Najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Thamer Ba Dhafari
- Division of Informatics, Imaging and Data Science, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Narges Azadbakht
- Division of Informatics, Imaging and Data Science, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - James Rafferty
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Glen Philip Martin
- Division of Informatics, Imaging and Data Science, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Seidu S, Alabraba V, Davies S, Newland-Jones P, Fernando K, Bain SC, Diggle J, Evans M, James J, Kanumilli N, Milne N, Viljoen A, Wheeler DC, Wilding JPH. SGLT2 Inhibitors - The New Standard of Care for Cardiovascular, Renal and Metabolic Protection in Type 2 Diabetes: A Narrative Review. Diabetes Ther 2024; 15:1099-1124. [PMID: 38578397 PMCID: PMC11043288 DOI: 10.1007/s13300-024-01550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/06/2024] [Indexed: 04/06/2024] Open
Abstract
A substantial evidence base supports the use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in the treatment of type 2 diabetes mellitus (T2DM). This class of medicines has demonstrated important benefits that extend beyond glucose-lowering efficacy to protective mechanisms capable of slowing or preventing the onset of long-term cardiovascular, renal and metabolic (CVRM) complications, making their use highly applicable for organ protection and the maintenance of long-term health outcomes. SGLT2is have shown cost-effectiveness in T2DM management and economic savings over other glucose-lowering therapies due to reduced incidence of cardiovascular and renal events. National and international guidelines advocate SGLT2i use early in the T2DM management pathway, based upon a plethora of supporting data from large-scale cardiovascular outcome trials, renal outcomes trials and real-world studies. While most people with T2DM would benefit from CVRM protection through SGLT2i use, prescribing hesitancy remains, potentially due to confusion concerning their place in the complex therapeutic paradigm, variation in licensed indications or safety perceptions/misunderstandings associated with historical data that have since been superseded by robust clinical evidence and long-term pharmacovigilance reporting. This latest narrative review developed by the Improving Diabetes Steering Committee (IDSC) outlines the place of SGLT2is within current evidence-informed guidelines, examines their potential as the standard of care for the majority of newly diagnosed people with T2DM and sets into context the perceived risks and proven advantages of SGLT2is in terms of sustained health outcomes. The authors discuss the cost-effectiveness case for SGLT2is and provide user-friendly tools to support healthcare professionals in the correct application of these medicines in T2DM management. The previously published IDSC SGLT2i Prescribing Tool for T2DM Management has undergone updates and reformatting and is now available as a Decision Tool in an interactive pdf format as well as an abbreviated printable A4 poster/wall chart.
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Affiliation(s)
- Samuel Seidu
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Vicki Alabraba
- Leicester Diabetes Centre, University Hospitals Leicester NHS Trust, Leicester, UK
| | | | | | | | - Stephen C Bain
- Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, UK
- Department of Diabetes and Endocrinology, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Jane Diggle
- College Lane Surgery, Ackworth, West Yorkshire, UK
| | - Marc Evans
- University Hospital Llandough, Cardiff, UK
| | - June James
- Leicester Diabetes Centre, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Naresh Kanumilli
- Brooklands Northenden Primary Care Network, Manchester, UK
- Manchester University Foundation Trust, Manchester, UK
| | - Nicola Milne
- Brooklands Northenden Primary Care Network, Manchester, UK
| | - Adie Viljoen
- Borthwick Diabetes Research Unit, Lister Hospital, Stevenage, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Clinical Sciences Centre, Aintree University Hospital, University of Liverpool, Liverpool, UK.
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Chukwusa E, Barclay S, Gulliford M, Harding R, Higginson I, Verne J. General practice service use at the end-of-life before and during the COVID-19 pandemic: a population-based cohort study using primary care electronic health records. BJGP Open 2024; 8:BJGPO.2023.0108. [PMID: 37993135 PMCID: PMC11169988 DOI: 10.3399/bjgpo.2023.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Globally, the COVID-19 pandemic has caused unprecedented strain in healthcare systems, but little is known about how it affected patients requiring palliative and end-of-life care from GPs. AIM To evaluate the impact of the pandemic on primary care service use in the last 3 months of life, including consultations and prescribing, and to identify associated factors. DESIGN AND SETTING A retrospective cohort study in UK, using data from the Clinical Practice Research Datalink. METHOD The study cohort included those who died between 2019 and 2020. Poisson regression models using generalised estimation equations were used to examine the association between primary care use and patient characteristics. Adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs) were estimated. RESULTS A total of 44 534 patients died during the study period. The pandemic period was associated with an 8.9% increase in the rate of consultations from 966.4 to 1052.9 per 1000 person-months, and 14.3% longer telephone consultation duration (from 10.1 to 11.5 minutes), with a switch from face-to-face to telephone or video consultations. The prescription of end-of-life care medications increased by 6.3%, from 1313.7 to 1396.3 per 1000 person-months. The adjusted rate ratios for consultations (aRR = 1.08, 95% CI = 1.06 to 1.10, P<0.001) and prescriptions (aRR 1.05: 95% CI = 1.03 to 1.07, P<0.001) also increased during the pandemic. CONCLUSION The pandemic had a major impact on GP service use, leading to longer consultations, shifts from face-to-face to telephone or video consultations, and increased prescriptions. GP workload-related issues must be addressed urgently to ease the pressure on GPs.
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Affiliation(s)
- Emeka Chukwusa
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Martin Gulliford
- Department of Population Health Sciences, King's College London, Faculty of Life Science & Medicine, London, UK
| | - Richard Harding
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Irene Higginson
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
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Khunti K, Chudasama YV, Gregg EW, Kamkuemah M, Misra S, Suls J, Venkateshmurthy NS, Valabhji J. Diabetes and Multiple Long-term Conditions: A Review of Our Current Global Health Challenge. Diabetes Care 2023; 46:2092-2101. [PMID: 38011523 DOI: 10.2337/dci23-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/26/2023] [Indexed: 11/29/2023]
Abstract
Use of effective treatments and management programs is leading to longer survival of people with diabetes. This, in combination with obesity, is thus contributing to a rise in people living with more than one condition, known as multiple long-term conditions (MLTC or multimorbidity). MLTC is defined as the presence of two or more long-term conditions, with possible combinations of physical, infectious, or mental health conditions, where no one condition is considered as the index. These include a range of conditions such as cardiovascular diseases, cancer, chronic kidney disease, arthritis, depression, dementia, and severe mental health illnesses. MLTC has major implications for the individual such as poor quality of life, worse health outcomes, fragmented care, polypharmacy, poor treatment adherence, mortality, and a significant impact on health care services. MLTC is a challenge, where interventions for prevention and management are lacking a robust evidence base. The key research directions for diabetes and MLTC from a global perspective include system delivery and care coordination, lifestyle interventions and therapeutic interventions.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Yogini V Chudasama
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Edward W Gregg
- School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Monika Kamkuemah
- Innovation Africa and Department of Architecture, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
| | - Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Jerry Suls
- Institute for Health System Science, Feinstein Institutes for Medical Research Northwell Health, New York, NY
| | - Nikhil S Venkateshmurthy
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
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Mellanen E, Kauppila T, Kautiainen H, Lehto M, Rahkonen O, Pitkälä K, Laine MK. Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities. Scand J Prim Health Care 2023; 41:392-399. [PMID: 37706640 PMCID: PMC11001330 DOI: 10.1080/02813432.2023.2255062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities. DESIGN AND SETTING A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018. SUBJECTS PHC patients aged 60 years or more with a T2D were included. MAIN OUTCOME MEASURES Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR). RESULTS In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39-1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39-1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74-1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86-0.96]). CONCLUSIONS In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities.Key PointsIn older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality.The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services.The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.
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Affiliation(s)
- E. Mellanen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - T. Kauppila
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H. Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - M. Lehto
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- City of Vantaa, Vantaa, Finland
| | - O. Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - K. Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M. K. Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
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Zghebi SS, Rutter MK, Sun LY, Ullah W, Rashid M, Ashcroft DM, Steinke DT, Weng S, Kontopantelis E, Mamas MA. Comorbidity clusters and in-hospital outcomes in patients admitted with acute myocardial infarction in the USA: A national population-based study. PLoS One 2023; 18:e0293314. [PMID: 37883354 PMCID: PMC10602297 DOI: 10.1371/journal.pone.0293314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The prevalence of multimorbidity in patients with acute myocardial infarction (AMI) is increasing. It is unclear whether comorbidities cluster into distinct phenogroups and whether are associated with clinical trajectories. METHODS Survey-weighted analysis of the United States Nationwide Inpatient Sample (NIS) for patients admitted with a primary diagnosis of AMI in 2018. In-hospital outcomes included mortality, stroke, bleeding, and coronary revascularisation. Latent class analysis of 21 chronic conditions was used to identify comorbidity classes. Multivariable logistic and linear regressions were fitted for associations between comorbidity classes and outcomes. RESULTS Among 416,655 AMI admissions included in the analysis, mean (±SD) age was 67 (±13) years, 38% were females, and 76% White ethnicity. Overall, hypertension, coronary heart disease (CHD), dyslipidaemia, and diabetes were common comorbidities, but each of the identified five classes (C) included ≥1 predominant comorbidities defining distinct phenogroups: cancer/coagulopathy/liver disease class (C1); least burdened (C2); CHD/dyslipidaemia (largest/referent group, (C3)); pulmonary/valvular/peripheral vascular disease (C4); diabetes/kidney disease/heart failure class (C5). Odds ratio (95% confidence interval [CI]) for mortality ranged between 2.11 (1.89-2.37) in C2 to 5.57 (4.99-6.21) in C1. For major bleeding, OR for C1 was 4.48 (3.78; 5.31); for acute stroke, ORs ranged between 0.75 (0.60; 0.94) in C2 to 2.76 (2.27; 3.35) in C1; for coronary revascularization, ORs ranged between 0.34 (0.32; 0.36) in C1 to 1.41 (1.30; 1.53) in C4. CONCLUSIONS We identified distinct comorbidity phenogroups that predicted in-hospital outcomes in patients admitted with AMI. Some conditions overlapped across classes, driven by the high comorbidity burden. Our findings demonstrate the predictive value and potential clinical utility of identifying patients with AMI with specific comorbidity clustering.
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Affiliation(s)
- Salwa S. Zghebi
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Pharmaceutics, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya
| | - Martin K. Rutter
- Diabetes, Endocrinology & Metabolism Centre, Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
| | - Louise Y. Sun
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States of America
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Keele University, Stoke‐on‐Trent, United Kingdom
- Department of Academic Cardiology, Royal Stoke University Hospital, Stoke‐on‐Trent, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Collaboration (PSRC), The University of Manchester, Manchester, United Kingdom
| | - Douglas T. Steinke
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Stephen Weng
- Development Biostatistics, GSK, Stevenage, United Kingdom
| | - Evangelos Kontopantelis
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Keele University, Stoke‐on‐Trent, United Kingdom
- Department of Academic Cardiology, Royal Stoke University Hospital, Stoke‐on‐Trent, United Kingdom
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Rosella LC, Negatu E, Kornas K, Chu C, Zhou L, Buajitti E. Multimorbidity at time of death among persons with type 2 diabetes: a population-based study in Ontario, Canada. BMC Endocr Disord 2023; 23:127. [PMID: 37264336 DOI: 10.1186/s12902-023-01362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Individuals with Type 2 Diabetes are likely to experience multimorbidity and accumulate multiple chronic conditions over their life. We aimed to identify causes of death and chronic conditions at the time of death in a population-based cohort, and to analyze variations in the presence of diabetes at the time of death overall and across income and immigrant status. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of 2,199,801 adult deaths from 1992 to 2017 in Ontario, Canada. We calculated the proportion of decedents with chronic conditions at time of death and causes of death. The risk of diabetes at the time of death was modeled across sociodemographic variables with a log binomial regression adjusting for sex, age, immigrant status, area-level income. comorbiditiesand time. RESULTS The leading causes of death in the cohort were cardiovascular and cancer. Decedents with diabetes had a higher prevalence of most chronic conditions than decedents without diabetes, including hypertension, osteo and other arthritis, chronic coronary syndrome, mood disorder, and congestive heart failure. The risk of diabetes at the time of death was 19% higher in immigrants (95%CI 1.18-1.20) and 15% higher in refugees (95%CI 1.12-1.18) compared to long-term residents, and 19% higher in the lowest income quintile (95%CI 1.18-1.20) relative to the highest income quintile, after adjusting for other covariates. CONCLUSIONS Individuals with diabetes have a greater multimorbidity burden at the time of death, underscoring the importance of multiple chronic disease management among those living with diabetes and further considerations of the social determinants of health.
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Affiliation(s)
- Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada.
- ICES, Toronto, ON, Canada.
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
- Temerty Faculty of Medicine, Toronto, Canada.
| | - Ednah Negatu
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Casey Chu
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | | | - Emmalin Buajitti
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada
- ICES, Toronto, ON, Canada
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Rosella LC, Kornas K, Negatu E, Zhou L. Variations in all-cause mortality, premature mortality and cause-specific mortality among persons with diabetes in Ontario, Canada. BMJ Open Diabetes Res Care 2023; 11:11/3/e003378. [PMID: 37130629 PMCID: PMC10163552 DOI: 10.1136/bmjdrc-2023-003378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Patients with diabetes have a higher risk of mortality compared with the general population. Large population-based studies that quantify variations in mortality risk for patients with diabetes among subgroups in the population are lacking. This study aimed to examine the sociodemographic differences in the risk of all-cause mortality, premature mortality, and cause-specific mortality in persons diagnosed with diabetes. RESEARCH DESIGN AND METHODS We conducted a population-based cohort study of 1 741 098 adults diagnosed with diabetes between 1994 and 2017 in Ontario, Canada using linked population files, Canadian census, health administrative and death registry databases. We analyzed the association between sociodemographics and other covariates on all-cause mortality and premature mortality using Cox proportional hazards models. A competing risk analysis using Fine-Gray subdistribution hazards models was used to analyze cardiovascular and circular mortality, cancer mortality, respiratory mortality, and mortality from external causes of injury and poisoning. RESULTS After full adjustment, individuals with diabetes who lived in the lowest income neighborhoods had a 26% (HR 1.26, 95% CI 1.25 to 1.27) increased hazard of all-cause mortality and 44% (HR 1.44, 95% CI 1.42 to 1.46) increased risk of premature mortality, compared with individuals with diabetes living in the highest income neighborhoods. In fully adjusted models, immigrants with diabetes had reduced risk of all-cause mortality (HR 0.46, 95% CI 0.46 to 0.47) and premature mortality (HR 0.40, 95% CI 0.40 to 0.41), compared with long-term residents with diabetes. Similar HRs associated with income and immigrant status were observed for cause-specific mortality, except for cancer mortality, where we observed attenuation in the income gradient among persons with diabetes. CONCLUSIONS The observed mortality variations suggest a need to address inequality gaps in diabetes care for persons with diabetes living in the lowest income areas.
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Affiliation(s)
- Laura C Rosella
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Kathy Kornas
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ednah Negatu
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Andersen JD, Jensen MH, Vestergaard P, Jensen V, Hejlesen O, Hangaard S. The multidisciplinary team in diagnosing and treatment of patients
with diabetes and comorbidities: A scoping review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231165966. [PMID: 36968789 PMCID: PMC10031602 DOI: 10.1177/26335565231165966] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
Background Multidisciplinary Teams (MDTs) has been suggested as an intervention to
overcome some of the complexities experienced by people with diabetes and
comorbidities in terms of diagnosis and treatment. However, evidence
concerning MDTs within the diabetes field remains sparse. Objective This review aims to identify and map available evidence on key
characteristics of MDTs in the context of diagnosis and treatment in people
with diabetes and comorbidities. Methods This review followed the PRISMA-ScR guidelines. Databases PubMed, EMBASE, and
CINAHL were systematically searched for studies assessing any type of MDT
within the context of diagnosis and treatment in adult people (≥ 18 years)
with diabetes and comorbidities/complications. Data extraction included
details on study characteristics, MDT interventions, digital health
solutions, and key findings. Results Overall, 19 studies were included. Generally, the MDTs were characterized by
high heterogeneity. Four overall components characterized the MDTs: Both
medical specialists and healthcare professionals (HCPs) of different team
sizes were represented; interventions spanned elements of medication,
assessment, nutrition, education, self-monitoring, and treatment adjustment;
digital health solutions were integrated in 58% of the studies; MDTs were
carried out in both primary and secondary healthcare settings with varying
frequencies. Generally, the effectiveness of the MDTs was positive across
different outcomes. Conclusions MDTs are characterized by high diversity in their outline yet seem to be
effective and cost-effective in the context of diagnosis and treatment of
people with diabetes and comorbidities. Future research should investigate
the cross-sectorial collaboration to reduce care fragmentation and enhance
care coordination.
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Affiliation(s)
- Jonas Dahl Andersen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
- Jonas Dahl Andersen, Department of Health
Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, DK-9260
Gistrup, Denmark.
| | - Morten Hasselstrøm Jensen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
- Department of Endocrinology and
Clinical Medicine, Aalborg
University Hospital,
Aalborg, Denmark
| | - Vigga Jensen
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
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10
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Bentué-Martínez C, Mimbrero MR, Zúñiga-Antón M. Spatial patterns in sociodemographic factors explain to a large extent the prevalence of hypertension and diabetes in Aragon (Spain). Front Med (Lausanne) 2023; 10:1016157. [PMID: 36760398 PMCID: PMC9905822 DOI: 10.3389/fmed.2023.1016157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction The global burden of multi-morbidity has become a major public health challenge due to the multi stakeholder action required to its prevention and control. The Social Determinants of Health approach is the basis for the establishment of health as a cross-cutting element of public policies toward enhanced and more efficient decision making for prevention and management. Objective To identify spatially varying relationships between the multi-morbidity of hypertension and diabetes and the sociodemographic settings (2015-2019) in Aragon (a mediterranean region of Northeastern Spain) from an ecological perspective. Materials and methods First, we compiled data on the prevalence of hypertension, diabetes, and sociodemographic variables to build a spatial geodatabase. Then, a Principal Component Analysis (PCA) was performed to derive regression variables, i.e., aggregating prevalence rates into a multi-morbidity component (stratified by sex) and sociodemographic covariate into a reduced but meaningful number of factors. Finally, we applied Geographically Weighted Regression (GWR) and cartographic design techniques to investigate the spatial variability of the relationships between multi-morbidity and sociodemographic variables. Results The GWR models revealed spatial explicit relationships with large heterogeneity. The sociodemographic environment participates in the explanation of the spatial behavior of multi-morbidity, reaching maximum local explained variance (R2) of 0.76 in men and 0.91 in women. The spatial gradient in the strength of the observed relationships was sharper in models addressing men's prevalence, while women's models attained more consistent and higher explanatory performance. Conclusion Modeling the prevalence of chronic diseases using GWR enables to identify specific areas in which the sociodemographic environment is explicitly manifested as a driving factor of multi-morbidity. This is step forward in supporting decision making as it highlights multi-scale contexts of vulnerability, hence allowing specific action suitable to the setting to be taken.
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Affiliation(s)
- Carmen Bentué-Martínez
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,*Correspondence: Carmen Bentué-Martínez, ✉
| | - Marcos Rodrigues Mimbrero
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,Institute of Research Into Environmental Sciences of the University of Zaragoza, Zaragoza, Spain
| | - María Zúñiga-Antón
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,Institute of Research Into Environmental Sciences of the University of Zaragoza, Zaragoza, Spain,Health Research Institute of Aragon, Zaragoza, Spain
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11
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Fatima F, Aleemuddin M, Ahmed MM, Anwer MK, Aldawsari MF, Soliman GA, Mahdi WA, Jafar M, Hamad AM, Alshehri S. Design and Evaluation of Solid Lipid Nanoparticles Loaded Topical Gels: Repurpose of Fluoxetine in Diabetic Wound Healing. Gels 2022; 9:gels9010021. [PMID: 36661789 PMCID: PMC9858001 DOI: 10.3390/gels9010021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
The current study aimed to prepare a topical gel containing solid lipid nanoparticles (SLNs) encapsulating fluoxetine for diabetic wound healing effects. Fluoxetine (FX) was loaded into SLNs by employing an emulsion solvent evaporation technique using stearic acid as a lipid, and soya lecithin as a surfactant. SLNs were then evaluated for particle size, polydispersity index (PDI), zeta potential (ZP), percent entrapment efficiency (%EE), percent drug loading (%DL), and in vitro drug release. The optimized SLN (FS3) composed of FX (100 mg), SA (150 mg), and SA (100 mg) displayed mean particle size (467.3 ± 2.2nm), PDI (0.435 ± 0.02), ZP (-32.2 ± 4.47mV), EE (95.8 ± 3.38%), and DL (16.4 ± 2.4%). FTIR and DSC studies denote drug-polymer compatibility and the amorphous nature of FX in the SLNs. The drug release at 24 h was found to be (98.89 ± 2.57%) which followed the fickian diffusion mechanism. SLN (FS3) was further loaded into carbopol gel and tested for pH, spreadability, and extrudability of pharmaceutical parameters. In-vitro release of FX from the SLN gel and plain gel was compared, diabetic wound healing gel (DWH) showed sustained drug delivery. An in vivo study was also performed for DWH gel in streptozotocin-induced diabetic rats. Histopathological examination exhibited DWH gel-treated wounds have increased hydroxyproline, cellular proliferation, a rise in the number of blood vessels, and the level of collagen synthesis. Thus, DWH gel-loaded SLN encapsulated with FX could be a potential carrier for the effective treatment and management of diabetic wounds.
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Affiliation(s)
- Farhat Fatima
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Correspondence: or
| | - Mohammad Aleemuddin
- Department of Community Medicine (SPM), MNR Medical College, MNR Nagar, Fasalwadi Narsapur Road, Sangareddy 502294, Telangana, India
| | - Mohammed Muqtader Ahmed
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Md. Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mohammed F. Aldawsari
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Gamal A. Soliman
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Pharmacology, College of Veterinary Medicine, Cairo University, Giza 12211, Egypt
| | - Wael A. Mahdi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammed Jafar
- Department of Pharmaceutics, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Abubaker M. Hamad
- Basic Sciences Department, Preparatory Year Deanship, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Pathophysiology, College of Health Sciences, AL-Rayan Colleges, Al-Hijra Road, Madinah Al Munawwarah 41411, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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12
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Dibato J, Montvida O, Ling J, Koye D, Polonsky WH, Paul SK. Temporal trends in the prevalence and incidence of depression and the interplay of comorbidities in patients with young- and usual-onset type 2 diabetes from the USA and the UK. Diabetologia 2022; 65:2066-2077. [PMID: 36059021 PMCID: PMC9630215 DOI: 10.1007/s00125-022-05764-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/03/2022] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS We aimed to investigate the prevalence and incidence of depression, and the interplay of cardiometabolic comorbidities, in the differentiation of depression risk between young-onset diabetes (diagnosis at age <40 years) and usual-onset diabetes (diagnosis at age ≥40 years). METHODS Using electronic medical records from the UK and USA, retrospective cohorts of adults with incident type 2 diabetes diagnosed between 2006 and 2017 were examined. Trends in the prevalence and incidence of depression, and risk of developing depression, in participants with young-onset type 2 diabetes compared with usual-onset type 2 diabetes were assessed separately by sex and comorbidity status. RESULTS In total 230,932/1,143,122 people with type 2 diabetes from the UK/USA (mean age 58/60 years, proportion of men 57%/46%) were examined. The prevalence of depression in the UK/USA increased from 29% (95% CI 28, 30)/22% (95% CI 21, 23) in 2006 to 43% (95% CI 42, 44)/29% (95% CI 28, 29) in 2017, with the prevalence being similar across all age groups. A similar increasing trend was observed for incidence rates. In the UK, compared with people aged ≥50 years with or without comorbidity, 18-39-year-old men and women had 23-57% and 20-55% significantly higher risks of depression, respectively. In the USA, compared with those aged ≥60 years with or without comorbidity, 18-39-year-old men and women had 5-17% and 8-37% significantly higher risks of depression, respectively. CONCLUSIONS/INTERPRETATION Depression risk has been increasing in people with incident type 2 diabetes in the UK and USA, particularly among those with young-onset type 2 diabetes, irrespective of other comorbidities. This suggests that proactive mental health assessment from the time of type 2 diabetes diagnosis in primary care is essential for effective clinical management of people with type 2 diabetes.
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Affiliation(s)
- John Dibato
- Melbourne EpiCentre, Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Olga Montvida
- Melbourne EpiCentre, Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Joanna Ling
- Melbourne EpiCentre, Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Digsu Koye
- Melbourne EpiCentre, Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - William H Polonsky
- Department of Family and Community Medicine, University of California, San Diego, CA, USA
| | - Sanjoy K Paul
- Melbourne EpiCentre, Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
- AstraZeneca, London, UK.
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13
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Sinclair AJ, Abdelhafiz AH. Multimorbidity, Frailty and Diabetes in Older People-Identifying Interrelationships and Outcomes. J Pers Med 2022; 12:1911. [PMID: 36422087 PMCID: PMC9695437 DOI: 10.3390/jpm12111911] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 08/11/2023] Open
Abstract
Multimorbidity and frailty are highly prevalent in older people with diabetes. This high prevalence is likely due to a combination of ageing and diabetes-related complications and other diabetes-associated comorbidities. Both multimorbidity and frailty are associated with a wide range of adverse outcomes in older people with diabetes, which are proportionally related to the number of morbidities and to the severity of frailty. Although, the multimorbidity pattern or cluster of morbidities that have the most adverse effect are not yet well defined, it appears that mental health disorders enhance the multimorbidity-related adverse outcomes. Therefore, comprehensive diabetes guidelines that incorporate a holistic approach that includes screening and management of mental health disorders such as depression is required. The adverse outcomes predicted by multimorbidity and frailty appear to be similar and include an increased risk of health care utilisation, disability and mortality. The differential effect of one condition on outcomes, independent of the other, still needs future exploration. In addition, prospective clinical trials are required to investigate whether interventions to reduce multimorbidity and frailty both separately and in combination would improve clinical outcomes.
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Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Rotherham General Hospital Foundation Trust, Rotherham S60 2UD, UK
| | - Ahmed H. Abdelhafiz
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham S60 2UD, UK
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14
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Sun LY, Zghebi SS, Eddeen AB, Liu PP, Lee DS, Tu K, Tobe SW, Kontopantelis E, Mamas MA. Derivation and External Validation of a Clinical Model to Predict Heart Failure Onset in Patients With Incident Diabetes. Diabetes Care 2022; 45:2737-2745. [PMID: 36107673 PMCID: PMC9862443 DOI: 10.2337/dc22-0894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/20/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Heart failure (HF) often develops in patients with diabetes and is recognized for its role in increased cardiovascular morbidity and mortality in this population. Most existing models predict risk in patients with prevalent rather than incident diabetes and fail to account for sex differences in HF risk factors. We derived sex-specific models in Ontario, Canada to predict HF at diabetes onset and externally validated these models in the U.K. RESEARCH DESIGN AND METHODS Retrospective cohort study using international population-based data. Our derivation cohort comprised all Ontario residents aged ≥18 years who were diagnosed with diabetes between 2009 and 2018. Our validation cohort comprised U.K. patients aged ≥35 years who were diagnosed with diabetes between 2007 and 2017. Primary outcome was incident HF. Sex-stratified multivariable Fine and Gray subdistribution hazard models were constructed, with death as a competing event. RESULTS A total of 348,027 Ontarians (45% women) and 54,483 U.K. residents (45% women) were included. At 1, 5, and 9 years, respectively, in the external validation cohort, the C-statistics were 0.81 (95% CI 0.79-0.84), 0.79 (0.77-0.80), and 0.78 (0.76-0.79) for the female-specific model; and 0.78 (0.75-0.80), 0.77 (0.76-0.79), and 0.77 (0.75-0.79) for the male-specific model. The models were well-calibrated. Age, rurality, hypertension duration, hemoglobin, HbA1c, and cardiovascular diseases were common predictors in both sexes. Additionally, mood disorder and alcoholism (heavy drinker) were female-specific predictors, while income and liver disease were male-specific predictors. CONCLUSIONS Our findings highlight the importance of developing sex-specific models and represent an important step toward personalized lifestyle and pharmacologic prevention of future HF development.
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Affiliation(s)
- Louise Y. Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - 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, Manchester, U.K
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
| | - Anan Bader Eddeen
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
| | - Peter P. Liu
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Douglas S. Lee
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Ted Rodgers Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Ted Rodgers Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
| | - Sheldon W. Tobe
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - 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, Manchester, U.K
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Staffordshire, U.K
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, U.K
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15
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Pearson-Stuttard J, Holloway S, Polya R, Sloan R, Zhang L, Gregg EW, Harrison K, Elvidge J, Jonsson P, Porter T. Variations in comorbidity burden in people with type 2 diabetes over disease duration: A population-based analysis of real world evidence. EClinicalMedicine 2022; 52:101584. [PMID: 35942273 PMCID: PMC9356197 DOI: 10.1016/j.eclinm.2022.101584] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background The prevalence of type 2 diabetes (T2DM) is increasing, but increasing longevity among persons with diagnosed diabetes may be is associated with more extensive and diverse types of morbidity. The extent and breadth of morbidity and how this varies across sub-groups is unclear and could have important clinical and public health implications. We aimed to estimate comorbidity profiles in people with T2DM and variations across sub-groups and over time. Methods We identified approximately 224,000 people with T2DM in the Discover-NOW dataset, a real-world primary care database from 2000 to 2020 covering 2.5 million people across North-West London, England, linked to hospital records. We generated a mixed prevalence and incidence study population through repeated annual cross sections, and included a broad set of 35 comorbidities covering traditional T2DM conditions, emerging T2DM conditions and other common conditions.We estimated annual age-standardised prevalence of comorbidities, over the course of the disease in people with T2DM and several sub-groups. Findings Multimorbidity (two or more chronic conditions) is common in people with T2DM and increasing, but the comorbidity profiles of people with T2DM vary substantially. Nearly 30% of T2DM patients had three or more comorbidities at diagnosis, increasing to 60% of patients ten years later. Two of the five commonest comorbidities at diagnosis were traditional T2DM conditions (hypertension (37%) and ischaemic heart disease (10%)) the other three were not (depression (15%), back pain (25%) and osteoarthritis (11%)). The prevalence of each increased during the course of the disease, with more than one in three patients having back pain and one in four having depression ten years post diagnosis.People with five or more comorbidities at diagnosis had higher prevalence of each of the 35 comorbidities. Hypertension (73%) was the commonest comorbidity at diagnosis in this group; followed by back pain (69%), depression (67%), asthma (45%) and osteoarthritis (36%). People with obesity at diagnosis had substantially different comorbidity profiles to those without, and the five commonest comorbidities were 50% more common in this group. Interpretation Preventative and clinical interventions alongside care pathways for people with T2DM should transition to reflect the diverse set of causes driving persistent morbidity. This would benefit both patients and healthcare systems alike. Funding The study was funded by the National Institute for Health and Care Excellence (NICE).
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Affiliation(s)
- Jonathan Pearson-Stuttard
- Health Analytics, Lane Clark & Peacock LLP, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sara Holloway
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Rosie Polya
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Rebecca Sloan
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Linxuan Zhang
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Edward W. Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- School of Population Health, Royal College of Surgeons of Ireland, University of Medicine and Health Sciences, Dublin, IR
| | - Katy Harrison
- National Institute for Health and Care Excellence, Manchester, UK
| | - Jamie Elvidge
- National Institute for Health and Care Excellence, Manchester, UK
| | - Pall Jonsson
- National Institute for Health and Care Excellence, Manchester, UK
| | - Thomas Porter
- Health Analytics, Lane Clark & Peacock LLP, London, UK
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16
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Corrao S, Natoli G, Nobili A, Mannucci PM, Perticone F, Arcoraci V, Argano C. The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes. Healthcare (Basel) 2022; 10:healthcare10081459. [PMID: 36011116 PMCID: PMC9408695 DOI: 10.3390/healthcare10081459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022] Open
Abstract
(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes.
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Affiliation(s)
- Salvatore Corrao
- Internal Medicine Department IGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy; (G.N.); (C.A.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
- Correspondence: or ; Tel.: +39-091-655-2065; Fax: +39-091-666-3167
| | - Giuseppe Natoli
- Internal Medicine Department IGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy; (G.N.); (C.A.)
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Pier Mannuccio Mannucci
- Scientific Direction, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Christiano Argano
- Internal Medicine Department IGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy; (G.N.); (C.A.)
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17
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Mather S, Fisher P, Nevitt S, Cherry MG, Maturana C, Warren JG, Noble A. The limited efficacy of psychological interventions for depression in people with Type 1 or Type 2 diabetes: An Individual Participant Data Meta-Analysis (IPD-MA). J Affect Disord 2022; 310:25-31. [PMID: 35490884 DOI: 10.1016/j.jad.2022.04.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with either Type 1/Type 2 diabetes experiencing anxiety or depression experience worse clinical and social outcomes. Efficacy of available psychological and pharmacological treatments for anxiety and depression is unclear. Aggregate data meta-analyses (AD-MAs) have failed to consider the clinical relevance of any change these treatments elicit. Thus, we sought to complete an individual participant data meta-analysis (IPD-MA) to evaluate this. METHODS Eligible RCTs of psychological treatments (PTs) and pharmacological treatments (PhTs) were systematically identified and assessed using the Cochrane Risk of Bias Tool-2. IPD was requested and Jacobson's methodology was used to determine the clinical relevance of symptom-change. Traditional effect sizes were calculated to permit comparison of trials providing and not providing IPD and to compare with AD-MAs. RESULTS Sufficient data was obtained to conduct an IPD-MA for PTs (12/25) but not PhTs (1/5). Across PT trials, rates of 'recovery' for depression post-intervention were low. Whilst significantly more treated patients did recover (17% [95% CI 0.10, 0.25]) than controls (9% [95% CI 0.03, 0.17]), the difference was small (6% [95% CI 0.02, 0.10]). LIMITATIONS Only 50% of eligible trials provided IPD; we were also only able to examine outcomes immediately following the end of an intervention. CONCLUSION Current psychological interventions offer limited benefit in treating anxiety and depression in people with Type 1 or Type 2 diabetes (83% remain depressed). More efficacious interventions are urgently needed.
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Affiliation(s)
- Sarah Mather
- Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom of Great Britain and Northern Ireland; Department of Psychology, University of Liverpool, United Kingdom of Great Britain and Northern Ireland.
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Sarah Nevitt
- Department of Health Data Science, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Camila Maturana
- Department of Health Sciences, University of York, United Kingdom of Great Britain and Northern Ireland
| | - Jasmine G Warren
- Department of Psychology, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Adam Noble
- Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
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18
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He Y, Patel CJ. Shared exposure liability of type 2 diabetes and other chronic conditions in the UK Biobank. Acta Diabetol 2022; 59:851-860. [PMID: 35348899 PMCID: PMC9085680 DOI: 10.1007/s00592-022-01864-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022]
Abstract
AIMS To investigate whether the cumulative exposure risks of incident T2D are shared with other common chronic diseases. RESEARCH DESIGN AND METHODS We first establish and report the cross-sectional prevalence, cross-sectional co-prevalence, and incidence of seven T2D-associated chronic diseases [hypertension, atrial fibrillation, coronary artery disease, obesity, chronic obstructive pulmonary disease (COPD), and chronic kidney and liver diseases] in the UK Biobank. We use published weights of genetic variants and exposure variables to derive the T2D polygenic (PGS) and polyexposure (PXS) risk scores and test their associations to incident diseases. RESULTS PXS was associated with higher levels of clinical risk factors including BMI, systolic blood pressure, blood glucose, triglycerides, and HbA1c in individuals without overt or diagnosed T2D. In addition to predicting incident T2D, PXS and PGS were significantly and positively associated with the incidence of all 7 other chronic diseases. There were 4% and 8% of individuals in the bottom deciles of PXS and PGS, respectively, who were prediabetic at baseline but had low risks of T2D and other chronic diseases. Compared to the remaining population, individuals in the top deciles of PGS and PXS had particularly high risks of developing chronic diseases. For instance, the hazard ratio of COPD and obesity for individuals in the top T2D PXS deciles was 2.82 (95% CI 2.39-3.35, P = 4.00 × 10-33) and 2.54 (95% CI 2.24-2.87, P = 9.86 × 10-50), respectively, compared to the remaining population. We also found that PXS and PGS were both significantly (P < 0.0001) and positively associated with the total number of incident diseases. CONCLUSIONS T2D shares polyexposure risks with other common chronic diseases. Individuals with an elevated genetic and non-genetic risk of T2D also have high risks of cardiovascular, liver, lung, and kidney diseases.
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Affiliation(s)
- Yixuan He
- Program in Bioinformatics and Integrative Genomics, Harvard Medical School, 10 Shattuck St, Boston, MA, 02215, USA
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck St, Boston, MA, USA
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck St, Boston, MA, USA.
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19
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Veugen MGJ, Onete VG, Henry RMA, Brunner-La Rocca HP, Koster A, Dagnelie PC, Schaper NC, Sep SJS, van der Kallen CJH, van Boxtel MPJ, Reesink KD, Schouten JS, Savelberg HHCM, Köhler S, Verhey FR, van den Bergh JPW, Schram MT, Stehouwer CDA. Health burden in type 2 diabetes and prediabetes in The Maastricht Study. Sci Rep 2022; 12:7337. [PMID: 35513556 PMCID: PMC9072328 DOI: 10.1038/s41598-022-11136-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Mortality in type 2 diabetes, is determined not only by classical complications, but also by comorbidities, and is linked to hyperglycaemia and apparent even in prediabetes. We aimed to comprehensively investigate, in a population-based cohort, health burden defined as the presence of comorbidities in addition to classical complications and cardiometabolic risk factors, in not only type 2 diabetes but also prediabetes. Such population-based study has not been performed previously. Extensive phenotyping was performed in 3,410 participants of the population-based Maastricht Study (15.0% prediabetes and 28.6% type 2 diabetes) to assess presence of 17 comorbidities, six classical complications, and ten cardiometabolic risk factors. These were added up into individual and combined sum scores and categorized. Group differences were studied with multinomial regression analyses adjusted for age and sex. Individuals with type 2 diabetes and prediabetes, as compared to normal glucose metabolism (NGM), had greater comorbidities, classical complications, cardiometabolic risk factors and combined sum scores (comorbidities sum score ≥ 3: frequencies (95% CI) 61.5% (57.6;65.4) and 41.2% (36.5;45.9) vs. 25.4% (23.5;27.4), p-trend < 0.001; classical complications ≥ 2 (26.6% (23.1;30.1; P < 0.001 vs. NGM) and 10.1% (7.8;12.7; P = 0.065 vs NGM) vs. 8.0% (6.9;9.3)); cardiometabolic risk factors ≥ 6 (39.7% (35.9;43.4) and 28.5% (24.5;32.6) vs. 14.0% (12.5;15.6); p-trend < 0.001); combined ≥ 8 (66.6% (62.7;70.5) and 48.4% (43.7;53.1) vs. 26.0%(24.1;28.0), p-trend < 0.001). Type 2 diabetes and prediabetes health burden was comparable to respectively 32 and 14 years of ageing. Our population-based study shows, independently of age and sex, a considerable health burden in both type 2 diabetes and prediabetes, which to a substantial extent can be attributed to comorbidities in addition to classical complications and cardiometabolic risk factors. Our findings emphasize the necessity of comorbidities' awareness in (pre)diabetes and for determining the exact role of hyperglycaemia in the occurrence of comorbidities.
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Affiliation(s)
- Marja G J Veugen
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
| | - Veronica G Onete
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre +, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology and MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Koen D Reesink
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Johannes S Schouten
- Department of Ophthalmology, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Hans H C M Savelberg
- Department of Human Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology and MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology and MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joop P W van den Bergh
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Center, Venlo, The Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
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20
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Jenssen C, Pietsch C. Stationäre Patienten mit der Nebendiagnose Diabetes mellitus: klinische Relevanz. DIABETOLOGE 2022. [PMCID: PMC9045025 DOI: 10.1007/s11428-022-00897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In deutschen Krankenhäusern werden jährlich etwa 3 Mio. Patienten mit Diabetes stationär behandelt, davon 93 % nicht wegen, sondern mit dieser Erkrankung. In einzelnen Fachabteilungen liegt bei bis zu 40 % der Patienten die Nebendiagnose Diabetes vor. Sie haben oft eine relevante Komorbidität und im Vergleich zu Krankenhauspatienten ohne Diabetes eine längere stationäre Verweildauer, entwickeln deutlich häufiger Komplikationen und müssen öfter kurzfristig wieder aufgenommen werden. In dieser Übersicht wird die klinische Relevanz der Nebendiagnose Diabetes mellitus für Krankenhauspatienten besprochen.
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Affiliation(s)
- Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland GmbH, 15344 Strausberg, Deutschland
| | - Cristine Pietsch
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland GmbH, 15344 Strausberg, Deutschland
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21
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Heikkala E, Mikkola I, Jokelainen J, Timonen M, Hagnäs M. Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study. BMC Health Serv Res 2021; 21:964. [PMID: 34521389 PMCID: PMC8442281 DOI: 10.1186/s12913-021-06989-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). Methods The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. Results Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72). Conclusions Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.
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Affiliation(s)
- Eveliina Heikkala
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland. .,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland. .,Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland.
| | - Ilona Mikkola
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
| | - Maria Hagnäs
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
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22
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Lim LF, Solmi M, Cortese S. Association between anxiety and hypertension in adults: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 131:96-119. [PMID: 34481847 DOI: 10.1016/j.neubiorev.2021.08.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
We assessed the association between anxiety and hypertension in adults via a systematic review/meta-analysis. We searched PubMed, Ovid, and PsycINFO through 27 March 2020 with no language or publication type restrictions and systematically contacted study authors for unpublished information/data. We meta-analysed 59 studies including a total of 4,012,775 participants. Study quality was rated with the Newcastle-Ottawa Scale and random-effects analyses were performed. A significant anxiety-hypertension association was found in cross-sectional (OR = 1.37, 95 % CI = 1.21-1.54) and prospective studies (OR = 1.40, 95 % CI = 1.23-1.59). In sensitivity analyses, results were influenced by method of hypertension diagnosis, but not by study quality, method of anxiety diagnosis, study population, and effect size type. In subgroup analyses, study location, in particular country economic status, but not participant age, influenced the results. Longitudinal data and theoretical literature indicate that anxiety may precede hypertension. These findings have important clinical implications for the early detection and treatment of both anxiety and hypertension. Suggestions for future research are discussed.
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Affiliation(s)
- Li-Faye Lim
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Marco Solmi
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, UK; Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Samuele Cortese
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK; Centre for Innovation in Mental Health, School of Psychology, University of Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
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23
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Ling JZJ, Montvida O, Khunti K, Zhang AL, Xue CC, Paul SK. Therapeutic inertia in the management of dyslipidaemia and hypertension in incident type 2 diabetes and the resulting risk factor burden: Real-world evidence from primary care. Diabetes Obes Metab 2021; 23:1518-1531. [PMID: 33651456 DOI: 10.1111/dom.14364] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate trends in the prevalence of hypertension and dyslipidaemia in incident type 2 diabetes (T2DM), time to antihypertensive (AHT) and lipid-lowering therapy (LLT), and the association with systolic blood pressure (SBP) and lipid control. RESEARCH DESIGN AND METHODS Using The Health Improvement Network UK primary care database, 254 925 people with incident T2DM and existing dyslipidaemia or hypertension were identified. Among those without atherosclerotic cardiovascular disease (ASCVD) history and not on AHT or LLT at diagnosis, the adjusted median months to initiating an AHT or an LLT, and the probabilities of high SBP or lipid levels over 2 years in people initiating therapy within or after 1 year were evaluated according to high and low ASCVD risk status. RESULTS At diabetes diagnosis, 66% and 66% had dyslipidaemia and hypertension, respectively. During 2005 to 2016, dyslipidaemia prevalence increased by 10% in people aged <60 years, while hypertension prevalence remained stable in all age groups. Among those with high ASCVD risk status in the age groups 18 to 39, 40 to 49, and 50 to 59 years, the median number of months to initiation of therapy were 20.4 (95% confidence interval [CI] 20.3-20.5), 10.9 (95% CI 10.8-11.0), and 9.5 (95% CI 9.4-9.6) in the dyslipidaemia subcohort, and 28.1 (95% CI 28.0-28.2), 19.2 (95% CI 19.1-19.3), and 19.9 (95% CI 19.8-20.0) in the hypertension subcohort. Among people with high and low ASCVD risk status, respectively, compared to early LLT initiators, those who initiated LLT after 1 year had a 65.3% to 85.3% and a 65.0% to 85.3% significantly higher probability of failing lipid control at 2 years of follow-up, while late AHT initiators had a 46.5% to 57.9% and a 40.0% to 58.7% significantly higher probability of failing SBP control. CONCLUSIONS Significant delay in initiating cardioprotective therapies was observed, and time to first prescription was similar in the primary prevention setting, irrespective of ASCVD risk status across all T2DM diagnosis age groups, resulting in poor risk factor control at 2 years of follow-up.
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Affiliation(s)
- Joanna Z J Ling
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anthony L Zhang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Charlie C Xue
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
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24
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Brewster S, Holt R, Price H. Introduction to the development of complex interventions. Postgrad Med J 2021; 98:895-899. [PMID: 34039699 DOI: 10.1136/postgradmedj-2021-139766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022]
Abstract
Healthcare interventions are complex, but have the potential to deliver more efficient, cost-effective care and improved health outcomes. Careful attention must be paid to their early planning and development to minimise research waste or interventions that fail to deliver what they set out to achieve. The Medical Research Council provides guidance to help intervention developers, encouraging an explicit and iterative approach. This article describes the Medical Research Council's guidance and introduces two frequently used tools that further support the process of intervention design.
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Affiliation(s)
- Sarah Brewster
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Richard Holt
- Faculty of Medicine, University of Southampton Division of Human Development and Health, Southampton, UK
| | - Hermione Price
- West Hampshire Community Diabetes Service, Southern Health NHS Foundation Trust, Southampton, UK
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