Health Burden in Type 2 Diabetes and Prediabetes - The Maastricht Study

Abstract

Background: Mortality in type 2 diabetes (T2D) and prediabetes is determined not only by classical complications, but also by comorbidities. Health burden in T2D and prediabetes, as defined by the presence of comorbidities, classical complications, and cardiometabolic risk factors, has not been comprehensively examined. We aimed to do so in a population-based study. Methods: 3,410 participants (15·0% with prediabetes and -through oversampling - 28·6% with T2D) of the Maastricht Study underwent extensive phenotyping to determine presence of 15 comorbidities, six classical complications, and ten cardiometabolic risk factors. These were added up into individual and combined sum scores and categorized. Group differences were studied with multinomial regression analyses adjusted for age and sex. Findings: Individuals with T2D and prediabetes, as compared to normal glucose metabolism (NGM), more often had a comorbidities sum score of ≥3 (frequencies (95% CI): 49·4%(45·3;53·4) and 28·9%(24·7;33·2) vs 19·5%(17·.8;21·.3), p-trend<0·001); a classical complication sum score of ≥2 (26·6%(23·1;30·1; p<0·001 vs NGM) and 10·1%(7·8;12·7; p=0·065 vs NGM) vs 8·0%(6·9;9·3)); a cardiometabolic risk factors sum score ≥6 (39·7%(35·9;43·4) and 28·5%(24·5;32·6) vs 14·0%(12·5;15·6); p-trend<0·001); and a combined sum score of ≥8 (60·7%(56·7;56·7;64·7) and 38·2%(33·8;42·7) vs 21·0%(19·2;22·9), p-trend<0·001). T2D and prediabetes health burden was comparable to respectively 29 and 11 years of ageing. Interpretation: Our population-based study shows, independently of age and sex, a considerable health burden in T2D and prediabetes, which to an important extent is related to non-classical comorbidities. These findings emphasize the need for awareness of comorbidities in (pre)diabetes and for defining the aetiological role of hyperglycaemia. Funding: EFRO, Province of Limburg, MUMC+. Declaration of Interest: The authors state no conflicts of interests. Ethical Approval: The study has been approved by the institutional medical ethical committee (NL31329.068.10) and the Minister of Health, Welfare and Sports of the Netherlands (Permit 131088-105234-PG). All participants gave written informed consent. The present study was reported as per the STROBE statement for observational cohort studies.