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We would like to thank Professor Kawada for their comments on our paper.
In our retrospective cohort study, we report gender-stratified prevalence rates (Figure 3B, Figure S7) and gender-stratified odds ratios (Figure 5) for all 18 comorbidities. We discussed these results in the paper as we found that the presence of T2D was associated with significantly higher risk for comorbidities in women and similar estimates were obtained when regression models were also adjusted for deprivation.
Our team co-authored the Nowakowska et al. paper and hence we recognise the methodological differences between both studies. Nevertheless, we also reported that depression prevalence was nearly double in women than in men (16.7% vs. 9% – Figure 3). We agree on the need for care for both physical and mental comorbidities in people with T2DM, as we noted in our discussion on the need for future studies to investigate the reasons for the observed gender differences, which may inform future gender-specific multimorbidity prevention and management strategies.
We fully agree that stress management is essential for people with T2DM, as we mention in the ‘Clinical implications’ section on the clinical need for mental health interventions, especially for young patients with T2DM.
SS Zghebi, DT Steinke, MK Rutter, DM Ashcroft.
Zghebi et al. conducted a prospective study to investigate physical and mental health comorbidities in patients with type 2 diabetes (T2D) (1). By conditional logistic regression models, odds ratio (95% CI) of T2D diagnosis for myocardial infarction, heart failure, and depression were 2.13 (1.85 to 2.46), 2.12 (1.84 to 2.43), and 1.75 (1.62 to 1.89), respectively. The authors also clarified that the risk of osteoarthritis, hypothyroidism, anxiety, schizophrenia and respiratory conditions were also selected as highly prevalent comorbidities in patients with T2D. I have some concerns about their study with special reference to causal association and sex difference.
Williams et al. conducted a 5-year follow-up study to examine the effects of stress on abnormal glucose metabolism (2). The primary outcome was the development of abnormal glucose metabolism such as impaired fasting glucose, impaired glucose tolerance, and T2D, and perceived stress predicted incident abnormal glucose metabolism in women but not men. Based on the sex difference on the association, stratified analysis by sex might be needed to investigate the risk of comorbidities in patients with T2D. In addition, stress management seems important to prevent comorbidities in patients with T2D. Although the mechanism of the association would be complicated, comprehensive management is indispensable for keeping quality of life in patients with T2D.
Regarding sex difference, Nowakowska et al. evaluated c...
Regarding sex difference, Nowakowska et al. evaluated comorbidity patterns in patients with T2D (3). Depression was predicted to affect 33% of females and 15% of males diagnosed with T2D, and the percentage in females was more than 2-fold higher than that in males. As comorbidities are common and mental health is a growing concern in patients with T2D, there is a need for cares of physical and mental comorbidities in this population, especially in females.
1. Zghebi SS, Steinke DT, Rutter MK, Ashcroft DM. Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data. BMJ Open. 2020 Jul 1;10(7):e033866.
2. Williams ED, Magliano DJ, Tapp RJ, Oldenburg BF, Shaw JE. Psychosocial stress predicts abnormal glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Ann Behav Med. 2013 Aug;46(1):62-72.
3. Nowakowska M, Zghebi SS, Ashcroft DM, Buchan I, Chew-Graham C, Holt T, Mallen C, Van Marwijk H, Peek N, Perera-Salazar R, Reeves D, Rutter MK, Weng SF, Qureshi N, Mamas MA, Kontopantelis E. The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med. 2019 Jul 25;17(1):145.