ArticlePloS one2012
Differential effects of comorbidity on antihypertensive and glucose-regulating treatment in diabetes mellitus--a cohort study.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: A systematic review.Diabetes, obesity & metabolism · 2018 · on this mapPooled it
- Management of vascular risk in people with multiple sclerosis at the time of diagnosis in England: A population-based study.Multiple sclerosis (Houndmills, Basingstoke, England) · 2023Article
- Article
- Regional prevalence of hypertension among people diagnosed with diabetes in Africa, a systematic review and meta-analysis.PLOS global public health · 2023Article
- Article
- Treatment variation related to comorbidity and complications in type 2 diabetes: A real world analysis.Medicine · 2018Observational
- Blood pressure control and cardiovascular risk in hypertensive patients with type 2 diabetes: The German T2Target registry.Journal of clinical hypertension (Greenwich, Conn.) · 2017Article
- Observational
- Examining the effects of comorbidities on disease-modifying therapy use in multiple sclerosis.Neurology · 2016Observational
- The impact of concordant and discordant comorbidities on patient-assessed quality of diabetes care.Health expectations : an international journal of public participation in health care and health policy · 2015Article
- Exploring the impact of chronic obstructive pulmonary disease (COPD) on diabetes control in diabetes patients: a prospective observational study in general practice.NPJ primary care respiratory medicine · 2015Observational
- Establishing chronic condition concordance and discordance with diabetes: a Delphi study.BMC family practice · 2015Article
- The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures.Journal of diabetes and its complications · 2015Article
- Glycaemic control, treatment satisfaction and quality of life in type 2 diabetes patients in Greece: The PANORAMA study Greek results.World journal of diabetes · 2015Article
- Observational
- Patient characteristics associated with measurement of routine diabetes care: an observational study.PloS one · 2015Observational
- The relationship of individual comorbid chronic conditions to diabetes care quality.BMJ open diabetes research & care · 2015Article
- Quality of diabetes care in Dutch care groups: no differences between diabetes patients with and without co-morbidity.International journal of integrated care · 2013Article
- Do treatment quality indicators predict cardiovascular outcomes in patients with diabetes?PloS one · 2013Article
- Blood pressure, vessel caliber, and retinal thickness in diabetes.Optometry and vision science : official publication of the American Academy of Optometry · 2012Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundComorbidity is often mentioned as interfering with "optimal" treatment decisions in diabetes care. It is suggested that diabetes-related comorbidity will increase adequate treatment, whereas diabetes-unrelated comorbidity may decrease this process of care. We hypothesized that these effects differ according to expected priority of the conditions.
methodsWe evaluated the relationship between comorbidity and treatment intensification in a study of 11,248 type 2 diabetes patients using the GIANTT (Groningen Initiative to Analyse type 2 diabetes Treatment) database. We formed a cohort of patients with a systolic blood pressure ≥ 140 mmHg (6,820 hypertensive diabetics), and a cohort of patients with an HbA1c ≥ 7% (3,589 hyperglycemic diabetics) in 2007. We differentiated comorbidity by diabetes-related or unrelated conditions and by priority. High priority conditions include conditions that are life-interfering, incident or requiring new medication treatment. We performed Cox regression analyses to assess association with treatment intensification, defined as dose increase, start, or addition of drugs.
resultsIn both the hypertensive and hyperglycemic cohort, only patients with incident diabetes-related comorbidity had a higher chance of treatment intensification (HR 4.48, 2.33-8.62 (p<0.001) for hypertensives; HR 2.37, 1.09-5.17 (p = 0.030) for hyperglycemics). Intensification of hypertension treatment was less likely when a new glucose-regulating drug was prescribed (HR 0.24, 0.06-0.97 (p = 0.046)). None of the prevalent or unrelated comorbidity was significantly associated with treatment intensification.
conclusionsDiabetes-related comorbidity induced better risk factor treatment only for incident cases, implying that appropriate care is provided more often when complications occur. Diabetes-unrelated comorbidity did not affect hypertension or hyperglycemia management, even when it was incident or life-interfering. Thus, the observed "undertreatment" in diabetes care cannot be explained by constraints caused by such comorbidity.
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