Concomitant endocrine pathology in type 2 diabetes patients and its effects on treatment efficiency
Keywords:type 2 diabetes mellitus, comorbidity, nodular goiter, hyperparathyroidism, hypothyroidism, autoimmune thyroiditis, social factors
Background. The problem of the prevalence of comorbid pathology among patients is becoming increasingly relevant. In comorbidity, certain diseases become atypical with increased risk of complications and the problem of polypragmasia, and patients’ adherence to treatment decreases. The purpose was to study the structure and frequency of concomitant endocrine pathology in patients with type 2 diabetes mellitus (DM) and its impact on treatment effectiveness. Materials and methods. The study involved 2,264 patients with type 2 DM (1,186 men and 1,078 women) who have received medical care at the Ukrainian Research and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues for the last 5 years. We have studied the frequency and structure of concomitant endocrine pathology in patients with type 2 DM, depending on the place of their residence, duration of type 2 DM, body mass index, the level of glycated hemoglobin (HbA1c), medical approaches, the presence of myocardial infarction (MI), stroke and diabetic foot syndrome. Results. HbA1c level in patients of both sexes, MI and stroke in men do not have a significant effect on the frequency of other endocrine pathology in patients with type 2 DM; on the contrary, area of residence, body mass index and diabetic foot syndrome in patients of both sexes have a significant effect, and duration of type 2 DM in patients of both sexes, MI and stroke in women have a moderate influence, which requires consideration when managing patients with type 2 DM. The incidence of other endocrine pathology grows with increasing BMI: in men — by 1.4 times, in women — by 1.3 times. The presence of another endocrine pathology in type 2 DM patients does not have a significant impact on the effectiveness of DM treatment. Conclusions. Further researches are needed to study the mechanisms underlying the significantly lower incidence of other endocrine pathology in patients with diabetic foot syndrome, the significantly higher incidence of other endocrine pathology in women, the absence of diffuse goiter in women with MI and stroke, isolated cases in men with MI and stroke, as well as a higher incidence of primary hyperparathyroidism in patients with type 2 DM and MI.
Chiang JI, Jani BD, Mair FS, et al. Associations between multimorbidity, all-cause mortality and glycaemia in people with type 2 diabetes: A systematic review. PLoS One. 2018 Dec 26;13(12):e0209585. doi: 10.1371/journal.pone.0209585.
International Diabetes Federation. IDF Diabetes Atlas. 8th Edition. 2017. Available from: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/134-idf-diabetes-atlas-8th-edition.html.
Diederichs C, Berger K, Bartels DB. The measurement of multiple chronic diseases – a systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci. 2011 Mar;66(3):301-11. doi: 10.1093/gerona/glq208.
Abbatecola AM, Bo M, Barbagallo M, et al. Severe hypoglycemia is associated with antidiabetic oral treatment compared with insulin analogs in nursing home patients with type 2 diabetes and dementia: results from the DIMORA study. J Am Med Dir Assoc. 2015 Apr;16(4):349.e7-12. doi: 10.1016/j.jamda.2014.12.014.
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009 Jul-Aug;7(4):357-63. doi: 10.1370/afm.983.
Schafer I, Hansen H, Schon G, et al. The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. First results from the multicare cohort study. BMC Health Serv Res. 2012 Apr 3;12:89. doi: 10.1186/1472-6963-12-89.
Baldwin LM, Klabunde CN, Green P, Barlow W, Wright G. In search of the perfect comorbidity measure for use with administrative claims data: does it exist? Med Care. 2006 Aug;44(8):745-53. doi: 10.1097/01.mlr.0000223475.70440.07.
Lee DS, Donovan L, Austin PC, et al. Comparison of coding of heart failure and comorbidities in administrative and clinical data for use in outcomes research. Med Care. 2005 Feb;43(2):182-8. doi: 10.1097/00005650-200502000-00012.
Lash TL, Mor V, Wieland D, Ferrucci L, Satariano W, Silliman RA. Methodology, design, and analytic techniques to address measurement of comorbid disease. J Gerontol A Biol Sci Med Sci. 2007 Mar;62(3):281-5. doi: 10.1093/gerona/62.3.281.
Oganov RG, Denisov IN, Simanenkov VI, et al. Comorbid pathology in clinical practice. Clinical recommendations. Cardiovascular Therapy and Prevention. 2017;16(6):5-56. (in Russian). doi: 10.15829/1728-8800-2017-6-5-56.
How to Cite
Copyright (c) 2019 Z.G. Krushinska
This work is licensed under a Creative Commons Attribution 4.0 International License.