Associations between multimorbidity, all-cause mortality and glycaemia in people with type 2 diabetes: a systematic review

Tu, W.-J., Chiang, J. I., Jani, B. D. , Mair, F. S. , Nicholl, B. I. , Furler, J., O’Neal, D., Jenkins, A., Condron, P. and Manski-Nankervis, J.-A. (2018) Associations between multimorbidity, all-cause mortality and glycaemia in people with type 2 diabetes: a systematic review. PLoS ONE, 13(12), e0209585. (doi:10.1371/journal.pone.0209585) (PMID:30586451)

Tu, W.-J., Chiang, J. I., Jani, B. D. , Mair, F. S. , Nicholl, B. I. , Furler, J., O’Neal, D., Jenkins, A., Condron, P. and Manski-Nankervis, J.-A. (2018) Associations between multimorbidity, all-cause mortality and glycaemia in people with type 2 diabetes: a systematic review. PLoS ONE, 13(12), e0209585. (doi:10.1371/journal.pone.0209585) (PMID:30586451)

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Abstract

Introduction: Type 2 diabetes (T2D) is a major health priority worldwide and the majority of people with diabetes live with multimorbidity (MM) (the co-occurrence of ≥2 chronic conditions). The aim of this systematic review was to explore the association between MM and all-cause mortality and glycaemic outcomes in people with T2D. Methods: The search strategy centred on: T2D, MM, comorbidity, mortality and glycaemia. Databases searched: MEDLINE, EMBASE, CINAHL Complete, The Cochrane Library, and SCOPUS. Restrictions included: English language, quantitative empirical studies. Two reviewers independently carried out: abstract and full text screening, data extraction, and quality appraisal. Disagreements adjudicated by a third reviewer. Results: Of the 4882 papers identified; 41 met inclusion criteria. The outcome was all-cause mortality in 16 studies, glycaemia in 24 studies and both outcomes in one study. There were 28 longitudinal cohort studies and 13 cross-sectional studies, with the number of participants ranging from 96–892,223. Included studies were conducted in high or upper-middle-income countries. Fifteen of 17 studies showed a statistically significant association between increasing MM and higher mortality. Ten of 14 studies showed no significant associations between MM and HbA1c. Four of 14 studies found higher levels of MM associated with higher HbA1c. Increasing MM was significantly associated with hypoglycaemia in 9/10 studies. There was no significant association between MM and fasting glucose (one study). No studies explored effects on glycaemic variability. Conclusions: This review demonstrates that MM in T2D is associated with higher mortality and hypoglycaemia, whilst evidence regarding the association with other measures of glycaemic control is mixed. The current single disease focused approach to management of T2D seems inappropriate. Our findings highlight the need for clinical guidelines to support a holistic approach to the complex care needs of those with T2D and MM, accounting for the various conditions that people with T2D may be living with.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Nicholl, Dr Barbara and Jani, Dr Bhautesh and Mair, Professor Frances
Authors: Tu, W.-J., Chiang, J. I., Jani, B. D., Mair, F. S., Nicholl, B. I., Furler, J., O’Neal, D., Jenkins, A., Condron, P., and Manski-Nankervis, J.-A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN:1932-6203
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2018 Chiang et al.
First Published:First published in PLoS ONE 13(12):e0209585
Publisher Policy:Reproduced under a Creative Commons License

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