Influence of chronic comorbidity and medication on the efficacy of treatment in patients with diabetes in general practice

Wami, W. M. , Buntinx, F., Bartholomeeusen, S., Goderis, G., Mathieu, C. and Aerts, M. (2013) Influence of chronic comorbidity and medication on the efficacy of treatment in patients with diabetes in general practice. British Journal of General Practice, 63(609), pp. 267-273. (doi:10.3399/bjgp13X665233) (PMID:23540483) (PMCID:PMC3609474)

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Abstract

Background: Evidence on the influence of comorbidity and comedication on clinical outcomes in patients with type 2 diabetes mellitus is scarce. Aim: To ascertain the effect of five chronic diseases (joint disorder, respiratory disease, anaemia, malignancy, depression) and three chronically used drugs (non-steroid anti-inflammatory drugs [NSAIDs], corticosteroids, antidepressants) on treatment for hypoglycaemia in patients with type 2 diabetes. Design and setting: Retrospective cohort study in a variety of practices across Flanders, Belgium. Method: A retrospective cohort study was conducted, based on data from Intego, a general practice-based continuous morbidity registry. Multiple logistic regression analysis was used to predict the change in glycosylated haemoglobin (HbA1c) levels related to comorbidity, comedication, and a combination of both in 3416 patients with type 2 diabetes. Adjustments were made for age, sex, and diabetes-treatment group (diet, oral antidiabetic drugs, combination treatment, insulin). Results: Concomitant joint and respiratory disorders, as well as the chronic use of NSAIDs and corticosteroids, either separately or in combination, were significantly associated with the worsening of HbA1c levels. Anaemia, depression, malignancy, and antidepressants had no statistically significant influence on the efficacy of treatment for hypoglycaemia. Conclusion: The presence of some comorbid diseases or drug use can impede the efficacy of treatment for type 2 diabetes. This finding supports the need to develop treatment recommendations, taking into account the presence of both chronic comorbidity and comedication. Further research must be undertaken to ascertain the effect other combinations of chronic diseases have on the efficacy of treatment of this and other diseases.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wami, Welcome
Authors: Wami, W. M., Buntinx, F., Bartholomeeusen, S., Goderis, G., Mathieu, C., and Aerts, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:British Journal of General Practice
Publisher:Royal College of General Practitioners
ISSN:0960-1643
ISSN (Online):1478-5242
Published Online:01 April 2013

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