Differential effects of comorbidity on antihypertensive and glucose-regulating treatment in diabetes mellitus--a cohort study.

Abstract

BACKGROUND:

Comorbidity 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.

METHODS:

We 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.

RESULTS:

In 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.

CONCLUSIONS:

Diabetes-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.

• Authors: Jaco Voorham, Flora M Haaijer-Ruskamp, Bruce H R Wolffenbuttel, Dick de Zeeuw, Ronald P Stolk, Petra Denig
• Journal: PloS one (PLoS One) Vol. 7 Issue 6 Pg. e38707 ( 2012) ISSN: 1932-6203 [Electronic] United States
• PMID: 22679516 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Hypoglycemic Agents

Topics

• Antihypertensive Agents (therapeutic use)
• Cohort Studies
• Diabetes Mellitus (drug therapy, physiopathology)
• Hypertension (drug therapy, physiopathology)
• Hypoglycemic Agents (therapeutic use)
• Proportional Hazards Models