Abstract
The burden of type 2 diabetes is growing, not only through increased incidence, but also through its comorbidities. Concordant comorbidities for type 2 diabetes, such as cardiovascular diseases, are considered expected outcomes of the disease or disease complications, while discordant comorbidities are not considered to be directly related to type 2 diabetes and are less extensively addressed under diabetes management. Here we show that the combination of concordant and discordant comorbidities appears frequently in persons with diabetes (75%). Persons with combined comorbidities visited family physicians more than persons with discordant, concordant or no comorbidity (17.3 ± 10.2, 11.6 ± 6.5, 8.7 ± 6.8, 6.3 ± 6.6 visits/person/year respectively, p < 0.0001). The risk of death during the study period was highest in persons with combined comorbidities and discordant only comorbidities (HR = 33.4; 95% CI 12.5–89.2 and HR = 33.5; 95% CI 11.7–95.8), emphasizing the contribution of discordant comorbidities to the outcome. Our study is unique as a long-term follow-up of an 11-year cohort of 9725 persons with new-onset type 2 diabetes. The findings highlight the contribution of discordant comorbidity to the burden of the disease. The high prevalence of the combination of both concordant and discordant comorbidities, and their appearance before the onset of type 2 diabetes, indicates a continuum of morbidity.
Highlights
The burden of type 2 diabetes is growing, through increased incidence, and through its comorbidities
Other diseases, such as depression, rheumatologic diseases, chronic lung disease and malignant diseases[6,7], are considered "discordant" to diabetes, as they are not directly related to the pathogenesis of diabetes and do not share similar risk factors. The risks of both concordant and discordant comorbidities increase with time in persons with type 2 diabetes[6]. Concordant comorbidities, such as cardiovascular diseases, are treated as part of the detailed protocol of care for diabetes management and are more likely to be the focus of the disease management plan[7]
We defined the onset of type 2 diabetes as the starting point of our study, but we soon realized that the most common situation is that comorbidities, both concordant and discordant, appear before and after the onset of type 2 diabetes
Summary
The burden of type 2 diabetes is growing, through increased incidence, and through its comorbidities. We followed a cohort of persons from the time of onset of type 2 diabetes for a period of 11 years. Persons without an exemption from national health insurance payments were dominant in all groups of comorbidities (Table 1).
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