The burden of diabetes-associated multiple long-term conditions on years of life spent and lost.
Journal
Nature medicine
ISSN: 1546-170X
Titre abrégé: Nat Med
Pays: United States
ID NLM: 9502015
Informations de publication
Date de publication:
01 Aug 2024
01 Aug 2024
Historique:
received:
03
10
2023
accepted:
11
06
2024
medline:
2
8
2024
pubmed:
2
8
2024
entrez:
1
8
2024
Statut:
aheadofprint
Résumé
Diabetes mellitus is a central driver of multiple long-term conditions (MLTCs), but population-based studies have not clearly characterized the burden across the life course. We estimated the age of onset, years of life spent and loss associated with diabetes-related MLTCs among 46 million English adults. We found that morbidity patterns extend beyond classic diabetes complications and accelerate the onset of severe MLTCs by 20 years earlier in life in women and 15 years earlier in men. By the age of 50 years, one-third of those with diabetes have at least three conditions, spend >20 years with them and die 11 years earlier than the general population. Each additional condition at the age of 50 years is associated with four fewer years of life. Hypertension, depression, cancer and coronary heart disease contribute heavily to MLTCs in older age and create the greatest community-level burden on years spent (813 to 3,908 years per 1,000 individuals) and lost (900 to 1,417 years per 1,000 individuals). However, in younger adulthood, depression, severe mental illness, learning disabilities, alcohol dependence and asthma have larger roles, and when they occur, all except alcohol dependence were associated with long periods of life spent (11-14 years) and all except asthma associated with many years of life lost (11-15 years). These findings provide a baseline for population monitoring and underscore the need to prioritize effective prevention and management approaches.
Identifiants
pubmed: 39090411
doi: 10.1038/s41591-024-03123-2
pii: 10.1038/s41591-024-03123-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Science Foundation Ireland (SFI)
ID : 22/RP/10091
Informations de copyright
© 2024. The Author(s).
Références
Gerstein, H. C. & Werstuck, G. H. Dysglycaemia, vasculopenia, and the chronic consequences of diabetes. Lancet Diabetes Endocrinol. 1, 71–78 (2013).
pubmed: 24622269
doi: 10.1016/S2213-8587(13)70025-1
Nathan, D. M. Long-term complications of diabetes mellitus. N. Engl. J. Med. 328, 1676–1685 (1993).
pubmed: 8487827
doi: 10.1056/NEJM199306103282306
Gregg, E. W. et al. Changes in diabetes-related complications in the United States, 1990–2010. N. Engl. J. Med. 370, 1514–1523 (2014).
pubmed: 24738668
doi: 10.1056/NEJMoa1310799
Harding, J. L., Pavkov, M. E., Magliano, D. J., Shaw, J. E. & Gregg, E. W. Global trends in diabetes complications: a review of current evidence. Diabetologia 62, 3–16 (2019).
pubmed: 30171279
doi: 10.1007/s00125-018-4711-2
Pearson-Stuttard, J. et al. Trends in leading causes of hospitalisation of adults with diabetes in England from 2003 to 2018: an epidemiological analysis of linked primary care records. Lancet Diabetes Endocrinol. 10, 46–57 (2022).
pubmed: 34861153
pmcid: 8672063
doi: 10.1016/S2213-8587(21)00288-6
Gregg, E. W. et al. Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data. Lancet 391, 2430–2440 (2018).
pubmed: 29784146
doi: 10.1016/S0140-6736(18)30314-3
Tomic, D., Salim, A., Morton, J. I., Magliano, D. J. & Shaw, J. E. Reasons for hospitalisation in Australians with type 2 diabetes compared to the general population, 2010–2017. Diabetes Res. Clin. Pract. 194, 110143 (2022).
pubmed: 36370894
doi: 10.1016/j.diabres.2022.110143
Gregg, E. W., Sattar, N. & Ali, M. K. The changing face of diabetes complications. Lancet Diabetes Endocrinol. 4, 537–547 (2016).
pubmed: 27156051
doi: 10.1016/S2213-8587(16)30010-9
Koyama, A. K. et al. Trends in lifetime risk and years of potential life lost from diabetes in the United States, 1997–2018. PLoS ONE 17, e0268805 (2022).
pubmed: 35609056
pmcid: 9129010
doi: 10.1371/journal.pone.0268805
Lingvay, I., Sumithran, P., Cohen, R. V. & le Roux, C. W. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. Lancet 399, 394–405 (2022).
pubmed: 34600604
doi: 10.1016/S0140-6736(21)01919-X
Kahn, S. E., Cooper, M. E. & Del Prato, S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet 383, 1068–1083 (2014).
pubmed: 24315620
doi: 10.1016/S0140-6736(13)62154-6
Dibato, J. E. et al. Association of cardiometabolic multimorbidity and depression with cardiovascular events in early-onset adult type 2 diabetes: a multiethnic study in the U.S. Diabetes Care 44, 231–239 (2021).
pubmed: 33177170
doi: 10.2337/dc20-2045
Barnett, K. et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380, 37–43 (2012).
pubmed: 22579043
doi: 10.1016/S0140-6736(12)60240-2
Whitty, C. J. M. et al. Rising to the challenge of multimorbidity. BMJ 368, l6964 (2020).
pubmed: 31907164
pmcid: 7190283
doi: 10.1136/bmj.l6964
Tran, J. et al. Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: a population-based cohort study. PLoS Med. 15, e1002513 (2018).
pubmed: 29509757
pmcid: 5839540
doi: 10.1371/journal.pmed.1002513
Cicek, M., Buckley, J., Pearson-Stuttard, J. & Gregg, E. W. Characterizing multimorbidity from type 2 diabetes: insights from clustering approaches. Endocrinol. Metab. Clin. North Am. 50, 531–558 (2021).
pubmed: 34399960
pmcid: 8383848
doi: 10.1016/j.ecl.2021.05.012
Khunti, K. et al. Diabetes and multiple long-term conditions: a review of our current global health challenge. Diabetes Care 46, 2092–2101 (2023).
pubmed: 38011523
doi: 10.2337/dci23-0035
Nowakowska, M. et al. The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med. 17, 145 (2019).
pubmed: 31345214
pmcid: 6659216
doi: 10.1186/s12916-019-1373-y
Stirland, L. E. et al. Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice. BMJ 368, m160 (2020).
pubmed: 32071114
pmcid: 7190061
doi: 10.1136/bmj.m160
Bisquera, A. et al. Identifying longitudinal clusters of multimorbidity in an urban setting: a population-based cross-sectional study. Lancet Reg. Health Eur. 3, 100047 (2021).
pubmed: 34557797
pmcid: 8454750
doi: 10.1016/j.lanepe.2021.100047
Aga, F., Dunbar, S. B., Kebede, T. & Gary, R. A. The role of concordant and discordant comorbidities on performance of self-care behaviors in adults with type 2 diabetes: a systematic review. Diabetes Metab. Syndr. Obes. 12, 333–356 (2019).
pubmed: 31114271
pmcid: 6497834
doi: 10.2147/DMSO.S186758
Narayan, K. M., Boyle, J. P., Thompson, T. J., Sorensen, S. W. & Williamson, D. F. Lifetime risk for diabetes mellitus in the United States. JAMA 290, 1884–1890 (2003).
pubmed: 14532317
doi: 10.1001/jama.290.14.1884
NHSE subsegment/condition definitions. Outcomes Based Healthcare https://outcomesbasedhealthcare.com/condition-definitions-overview/ (2018).
NHS England segmentation dataset reference guide—comparison against QOF. Outcomes Based Healthcare https://outcomesbasedhealthcare.com/nhse-segmentation-dataset-reference-guide/#comparison-to-QOF (2024).
Herrett, E. et al. Data resource profile: Clinical Practice Research Datalink (CPRD). Int J. Epidemiol. 44, 827–836 (2015).
pubmed: 26050254
pmcid: 4521131
doi: 10.1093/ije/dyv098
Ho, I. S. et al. Variation in the estimated prevalence of multimorbidity: systematic review and meta-analysis of 193 international studies. BMJ Open 12, e057017 (2022).
pubmed: 35487738
pmcid: 9058768
doi: 10.1136/bmjopen-2021-057017
Valabhji, J. et al. Prevalence of multiple long-term conditions (multimorbidity) in England: a whole population study of over 60 million people. J. R. Soc. Med. 117, 104–117 (2023).
pubmed: 37905525
pmcid: 11046366
doi: 10.1177/01410768231206033
Aguado, A., Moratalla-Navarro, F., López-Simarro F. & Moreno, V. MorbiNet: multimorbidity networks in adult general population. Analysis of type 2 diabetes mellitus comorbidity. Sci. Rep. https://doi.org/10.1038/s41598-020-59336-1 (2020).
Holt, R. I. & Mitchell, A. J. Diabetes mellitus and severe mental illness: mechanisms and clinical implications. Nat. Rev. Endocrinol. 11, 79–89 (2015).
pubmed: 25445848
doi: 10.1038/nrendo.2014.203
Mezuk, B., Eaton, W. W., Albrecht, S. & Golden, S. H. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 31, 2383–2390 (2008).
pubmed: 19033418
pmcid: 2584200
doi: 10.2337/dc08-0985
Khunti, K. F. et al. Weight change and risk of obesity-related complications: a retrospective population-based cohort study of a UK primary care database. Diabetes Obes. Metab. 25, 2669–2679 (2023).
doi: 10.1111/dom.15154
Zghebi, S. S., Steinke, D. T., Rutter, M. K. & Ashcroft, D. M. Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data. BMJ Open 10, e033866 (2020).
pubmed: 32611677
doi: 10.1136/bmjopen-2019-033866
Tomic, D., Shaw, J. E. & Magliano, D. J. The burden and risks of emerging complications of diabetes mellitus. Nat. Rev. Endocrinol. 18, 525–539 (2022).
pubmed: 35668219
pmcid: 9169030
doi: 10.1038/s41574-022-00690-7
Sattar, N., McMurray, J. J. V., McInnes, I. B., Aroda, V. R. & Lean, M. E. J. Treating chronic diseases without tackling excess adiposity promotes multimorbidity. Lancet Diabetes Endocrinol. 11, 58–62 (2023).
pubmed: 36460014
doi: 10.1016/S2213-8587(22)00317-5
Langenberg, C., Hingorani, A. D. & Whitty, C. J. M. Biological and functional multimorbidity-from mechanisms to management. Nat. Med. 29, 1649–1657 (2023).
pubmed: 37464031
doi: 10.1038/s41591-023-02420-6
Bellass, S. et al. Living with diabetes alongside a severe mental illness: a qualitative exploration with people with severe mental illness, family members and healthcare staff. Diabet. Med. 38, e14562 (2021).
pubmed: 33772867
doi: 10.1111/dme.14562
Kivimäki, M. et al. Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes Endocrinol. 10, 253–263 (2022).
pubmed: 35248171
pmcid: 8938400
doi: 10.1016/S2213-8587(22)00033-X
Dhalwani, N. N. et al. Association between lifestyle factors and the incidence of multimorbidity in an older English population. J. Gerontol. A Biol. Sci. Med. Sci. 72, 528–534 (2017).
pubmed: 27470302
Smith, S. M., Wallace, E., Clyne, B., Boland, F. & Fortin, M. Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review. Syst. Rev. 10, 271 (2021).
pubmed: 34666828
pmcid: 8527775
doi: 10.1186/s13643-021-01817-z
Burton, M. J. et al. The Lancet Global Health Commission on global eye health: vision beyond 2020. Lancet Glob. Health 9, e489–e551 (2021).
pubmed: 33607016
pmcid: 7966694
doi: 10.1016/S2214-109X(20)30488-5
Barron, E. et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol. 8, 813–822 (2020).
pubmed: 32798472
pmcid: 7426088
doi: 10.1016/S2213-8587(20)30272-2
NHS England. NCDR Reference Library. UK Government Web Archive https://webarchive.nationalarchives.gov.uk/ukgwa/20231101051610/https://data.england.nhs.uk/ncdr/database/ (archived 1 November 2023).
Lynn, J., Straube, B. M., Bell, K. M., Jencks, S. F. & Kambic, R. T. Using population segmentation to provide better health care for all: the ‘Bridges to Health’ model. Milbank Q. 85, 185–208 (2007).
pubmed: 17517112
pmcid: 2690331
doi: 10.1111/j.1468-0009.2007.00483.x
Hafezparast, N. et al. Adapting the definition of multimorbidity—development of a locality-based consensus for selecting included long term conditions. BMC Fam. Pract. 22, 124 (2021).
pubmed: 34162331
pmcid: 8223362
doi: 10.1186/s12875-021-01477-x
Enhanced services (ES), vaccination and immunisation (V&I) and core contract components (CC) business rules 2023–2024. NHS Digital https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-collections/quality-and-outcomes-framework-qof/quality-and-outcome-framework-qof-business-rules/enhanced-services-es-vaccination-and-immunisation-vi-and-core-contract-components-cc-business-rules-2023-2024 (2023).
Meira-Machado, L., de Uña-Alvarez, J., Cadarso-Suárez, C. & Andersen, P. K. Multi-state models for the analysis of time-to-event data. Stat. Methods Med. Res. 18, 195–222 (2009).
pubmed: 18562394
doi: 10.1177/0962280208092301
Sonnenberg, F. A. & Beck, J. R. Markov models in medical decision making: a practical guide. Med. Decis. Making 13, 322–338 (1993).
pubmed: 8246705
doi: 10.1177/0272989X9301300409