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

Objectives
To compare the patterns of 18 physical and mental health comorbidities between people with recently diagnosed type 2 diabetes (T2D) and people without diabetes and how these change by age, gender and deprivation over time between 2004 and 2014. Also, to develop a metric to identify most prevalent comorbidities in people with T2D.

Design
Population-based cohort study.

Setting
Primary and secondary care, England, United Kingdom.

Participants
108,588 people with T2D and 528,667 comparators registered in 391 English general practices. Each T2D patient aged ≥16 years with T2D between January 2004 and December 2014 registered in Clinical Practice Research Datalink GOLD practices was matched to up to five comparators without diabetes on age, gender and general practice.
Primary and secondary outcome measures
Prevalence of 18 physical and mental health comorbidities in people with T2D and comparators categorised by age, gender, and deprivation. Odds for association between T2D diagnosis and comorbidities versus comparators. A metric for comorbidities with prevalence of ≥5% and/or odds ≥2 in patients with T2D.

Results
Overall, 77% of T2D patients had ≥1 comorbidity and all comorbidities were more prevalent in patients with T2D than in comparators. Across both groups, prevalence rates were higher in older people, women, and those most socially-deprived. Conditional logistic regression models fitted to estimate odds ratio (OR, 95%CI) for association between T2D diagnosis and comorbidities showed that T2D diagnosis was significantly associated with higher odds for all conditions including myocardial infarction (OR: 2.13, 95%CI 1.85 to 2.46); heart failure (OR: 2.12, 1.84 to 2.43); depression (OR: 1.75, 1.62 to 1.89), but non-significant for cancer (OR: 1.12, 0.98 to 1.28). In addition to cardiovascular disease, the metric identified osteoarthritis, hypothyroidism, anxiety, schizophrenia, and respiratory conditions as highly prevalent comorbidities in people with T2D.

Conclusions
T2D diagnosis is associated with higher likelihood of experiencing other physical and mental illnesses. People with T2D are twice as likely to have cardiovascular disease as the general population. The findings highlight highly prevalent and underreported comorbidities in people with T2D. These findings can inform future research and clinical guidelines and can have important implications on healthcare resource allocation and highlight the need for more holistic clinical care for people with recently diagnosed T2D.