Article Text

Original research
Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice
  1. Jason I Chiang1,
  2. John Furler1,
  3. Frances Mair2,
  4. Bhautesh D Jani2,
  5. Barbara I Nicholl2,
  6. Sharmala Thuraisingam1,
  7. Jo-Anne Manski-Nankervis1
  1. 1Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Victoria, Australia
  2. 2General Practice and Primary Care, University of Glasgow, Glasgow, UK
  1. Correspondence to Jason I Chiang; jason.chiang{at}unimelb.edu.au

Abstract

Objectives To explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).

Design Cross-sectional study.

Setting Australian general practice.

Participants 69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).

Primary and secondary outcome measures Prevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).

Results Mean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.

Conclusions Multimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.

  • diabetes & endocrinology
  • epidemiology
  • primary care
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @FrancesMair, @bhauteshjani, @BarbNicholl, @jo_manski

  • Contributors JC, JF, FM, BJ, BIN, ST and JMN contributed to the study protocol. JC, JF, FM, BJ, BIN, ST and JMN contributed to the study design. JC analysed the data and drafted the initial draft of the manuscript. JC had full access to all study data, performed all the statistical analyses, and takes responsibility for the integrity of the data and the accuracy of data analyses. All authors assisted with iterative drafting of the manuscript and agree with the manuscript results and conclusions. All authors read and approved the final manuscript.

  • Funding This work was supported by the Royal Australian College of General Practitioners Family Medical Care Education and Research (FMCER) Grant 2017 (FMC17a 565484).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval for this study was obtained from the Human Research Ethics Committee at the University of Melbourne (Ethics ID 1759587). Data access was approved by the independent Data Governance Committee for MedicineInsight (Ref: 002–2015)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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