Exploring the impact of chronic obstructive pulmonary disease (COPD) on diabetes control in diabetes patients: a prospective observational study in general practice

Hilde D Luijks,Chris Van Weel,Antoine Lm Lagro-Janssen,Jacobus Hj Bor,Marion Cj Biermans,Tjard R Schermer,Wim Jc De Grauw

doi:10.1038/npjpcrm.2015.32

Abstract

Background:Little is known about the association between COPD and diabetes control parameters.Aims:To explore the association between comorbid COPD and longitudinal glycaemic control (HbA1C) and systolic blood pressure (SBP) in a primary care cohort of diabetes patients.Methods:This is a prospective cohort study of type 2 diabetes patients in the Netherlands. In a mixed model analysis, we tested differences in the 5-year longitudinal development of HbA1C and SBP according to COPD comorbidity (present/absent). We corrected for relevant covariates. In subgroup effect analyses, we tested whether potential differences between diabetes patients with/without COPD were modified by age, sex, socio-economic status (SES) and body mass index (BMI).Results:We analysed 610 diabetes patients. A total of 63 patients (10.3%) had comorbid COPD. The presence of COPD was not significantly associated with the longitudinal development of HbA1C (P=0.54) or SBP (P=0.33), but subgroup effect analyses showed significant effect modification by SES (P<0.01) and BMI (P=0.03) on SBP. Diabetes patients without COPD had a flat SBP trend over time, with higher values in patients with a high BMI. For diabetes patients with COPD, SBP gradually increased over time in the middle- and high-SES groups, and it decreased over time in those in the low-SES group.Conclusions:The longitudinal development of HbA1C was not significantly associated with comorbid COPD in diabetes patients. The course of SBP in diabetes patients with COPD is significantly associated with SES (not BMI) in contrast to those without COPD. Comorbid COPD was associated with longitudinal diabetes control parameters, but it has complex interactions with other patient characteristics. Further research is needed.

Highlights

Chronic obstructive pulmonary disease (COPD) is typically diagnosed in middle-aged subjects who have an increased risk for other chronic conditions.[1]
We explored the association between comorbid COPD and the longitudinal development of HbA1C and systolic blood pressure (SBP) in a representative cohort of newly diagnosed type 2 diabetes patients in primary care during 5 years of follow-up
The initial analyses showed no significant associations between COPD and these outcomes, but subgroup effect analysis indicated that, in the presence of COPD, the development of SBP was different for patients from different socio-economic status (SES) and body mass index (BMI) subgroups

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is typically diagnosed in middle-aged subjects who have an increased risk for other chronic conditions.[1] The presence of other diseases in addition to an ‘index disease’ is defined as comorbidity.[2] Among patients with mild-to-moderate COPD, the main causes of death are comorbid diseases such as lung cancer and cardiovascular diseases.[3] COPD has a large impact on morbidity and mortality.[4] Another example of a chronic disease with marked effects on global health and health care is type 2 diabetes.[4,5] Of all patients with COPD, 9–13% of the patients have comorbid diabetes,[6,7,8,9] and 4–13% of patients with diabetes have comorbid COPD.[9,10,11] these numbers originate from different studies and are not directly comparable, they clearly illustrate that the combination of COPD and diabetes is a rather common one. CONCLUSIONS: The longitudinal development of HbA1C was not significantly associated with comorbid COPD in diabetes patients.

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