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The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort.

• アブストラクト	BACKGROUND: The presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions. METHODS: We used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation. RESULTS: More people living in the most deprived areas had >/= 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics. CONCLUSIONS: Comorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.
  ジャーナル名	BMC medicine
  投稿日	2019/7/28
  投稿者	Nowakowska, Magdalena; Zghebi, Salwa S; Ashcroft, Darren M; Buchan, Iain; Chew-Graham, Carolyn; Holt, Tim; Mallen, Christian; Van Marwijk, Harm; Peek, Niels; Perera-Salazar, Rafael; Reeves, David; Rutter, Martin K; Weng, Stephen F; Qureshi, Nadeem; Mamas, Mamas A; Kontopantelis, Evangelos
  組織名	NIHR School for Primary Care Research, Centre for Primary Care and Health;Services Research, Manchester Academic Health Science Centre (MAHSC), University;of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.;magdalena.nowakowska@manchester.ac.uk.;Division of Population Health, Health Services Research & Primary Care, School of;Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic;Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson;Building, Manchester, M13 9PL, UK. magdalena.nowakowska@manchester.ac.uk.;Building, Manchester, M13 9PL, UK.;Division of Pharmacy and Optometry, School of Health Sciences, Faculty of;Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC),;University of Manchester, Manchester, M13 9PL, UK.;NIHR Greater Manchester Patient Safety Translational Research Centre, University;of Manchester, Manchester, M13 9PL, UK.;Division of Informatics, Imaging, and Data Science, School of Health Sciences,;Faculty of Biology, Medicine and Health, Manchester Academic Health Science;Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.;Department of Public Health and Policy, Institute of Population Health Sciences,;University of Liverpool, Liverpool, L69 3BX, UK.;Research Institute for Primary Care and Health Sciences, Faculty of Medicine and;Health Sciences, Keele University, DJW 1.54a, Staffordshire, ST5 5BJ, UK.;Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford, OX2 6GG, UK.;Division of Primary Care and Public Health, Brighton and Sussex Medical School,;University of Sussex, Brighton, BN1 9PH, UK.;NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science;Centre for Biostatistics, Division of Population Health, Health Services Research;and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and;Health, University of Manchester, Manchester, M13 9PL, UK.;Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medicine,;Biology and Health, University of Manchester, Manchester, M13 9PL, UK.;Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester;University NHS Foundation Trust, Manchester, M13 0JE, UK.;Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of;Medicine, University of Nottingham, Nottingham, NG7 2RD, UK.;Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for;Primary Care and Health Sciences, Keele University, Stoke-on-Trent, ST4 7QB, UK.
  Pubmed リンク	https://www.ncbi.nlm.nih.gov/pubmed/31345214/

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