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. 2018 Dec 26;13(12):e0209585.
doi: 10.1371/journal.pone.0209585. eCollection 2018.

Associations between multimorbidity, all-cause mortality and glycaemia in people with type 2 diabetes: A systematic review

Jason I Chiang  1 , Bhautesh Dinesh Jani  2 , Frances S Mair  2 , Barbara I Nicholl  2 , John Furler  1 , David O'Neal  3 , Alicia Jenkins  4 , Patrick Condron  5 , Jo-Anne Manski-Nankervis  1
Affiliations

Associations between multimorbidity, all-cause mortality and glycaemia in people with type 2 diabetes: A systematic review

Jason I Chiang et al. PLoS One. .

Abstract

Introduction: Type 2 diabetes (T2D) is a major health priority worldwide and the majority of people with diabetes live with multimorbidity (MM) (the co-occurrence of ≥2 chronic conditions). The aim of this systematic review was to explore the association between MM and all-cause mortality and glycaemic outcomes in people with T2D.

Methods: The search strategy centred on: T2D, MM, comorbidity, mortality and glycaemia. Databases searched: MEDLINE, EMBASE, CINAHL Complete, The Cochrane Library, and SCOPUS. Restrictions included: English language, quantitative empirical studies. Two reviewers independently carried out: abstract and full text screening, data extraction, and quality appraisal. Disagreements adjudicated by a third reviewer.

Results: Of the 4882 papers identified; 41 met inclusion criteria. The outcome was all-cause mortality in 16 studies, glycaemia in 24 studies and both outcomes in one study. There were 28 longitudinal cohort studies and 13 cross-sectional studies, with the number of participants ranging from 96-892,223. Included studies were conducted in high or upper-middle-income countries. Fifteen of 17 studies showed a statistically significant association between increasing MM and higher mortality. Ten of 14 studies showed no significant associations between MM and HbA1c. Four of 14 studies found higher levels of MM associated with higher HbA1c. Increasing MM was significantly associated with hypoglycaemia in 9/10 studies. There was no significant association between MM and fasting glucose (one study). No studies explored effects on glycaemic variability.

Conclusions: This review demonstrates that MM in T2D is associated with higher mortality and hypoglycaemia, whilst evidence regarding the association with other measures of glycaemic control is mixed. The current single disease focused approach to management of T2D seems inappropriate. Our findings highlight the need for clinical guidelines to support a holistic approach to the complex care needs of those with T2D and MM, accounting for the various conditions that people with T2D may be living with.

Systematic review registration: International Prospective Register of Systematic Reviews CRD42017079500.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram.
Fig 2
Fig 2. Summary of all-cause mortality outcome papers.
Fig 3
Fig 3. Summary of glycaemic outcomes papers.
See this image and copyright information in PMC

References

    1. International Diabetes Federation. IDF Diabetes Atlas 8th Edition. 2017.
    1. Australian Bureau of Statistics. National Health Survey: First Result, 2014–15. 2015.
    1. Harris MF, Dennis S, Pillay M. Multimorbidity: Negotiating priorities and making progress. AFP. 2013;42(12):850–4. - PubMed
    1. Mair FS, May CR. Thinking about the burden of treatment. Bmj. 2014;349:g6680 10.1136/bmj.g6680 . - DOI - PubMed
    1. Fortin M, Lapointe L, Hudon C, Vanasse A. Multimorbidity is common to family practice: is it commonly researched? Canadian family physician Medecin de famille canadien. 2005;51:244–5. ; PubMed Central PMCID: PMC1472978. - PMC - PubMed

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