title: Influence of chronic comorbidity and medication on the efficacy of treatment in patients with diabetes in general practice.
abstract: BACKGROUND
  Evidence on the influence of comorbidity and comedication on clinical outcomes in patients with type 2 diabetes mellitus is scarce.
  
  
  OBJECTIVE
  To ascertain the effect of five chronic diseases (joint disorder, respiratory disease, anaemia, malignancy, depression) and three chronically used drugs (non-steroid anti-inflammatory drugs [NSAIDs], corticosteroids, antidepressants) on treatment for hypoglycaemia in patients with type 2 diabetes.
  
  
  METHODS
  Retrospective cohort study in a variety of practices across Flanders, Belgium.
  
  
  METHODS
  A retrospective cohort study was conducted, based on data from Intego, a general practice-based continuous morbidity registry. Multiple logistic regression analysis was used to predict the change in glycosylated haemoglobin (HbA1c) levels related to comorbidity, comedication, and a combination of both in 3416 patients with type 2 diabetes. Adjustments were made for age, sex, and diabetes-treatment group (diet, oral antidiabetic drugs, combination treatment, insulin).
  
  
  RESULTS
  Concomitant joint and respiratory disorders, as well as the chronic use of NSAIDs and corticosteroids, either separately or in combination, were significantly associated with the worsening of HbA1c levels. Anaemia, depression, malignancy, and antidepressants had no statistically significant influence on the efficacy of treatment for hypoglycaemia.
  
  
  CONCLUSIONS
  The presence of some comorbid diseases or drug use can impede the efficacy of treatment for type 2 diabetes. This finding supports the need to develop treatment recommendations, taking into account the presence of both chronic comorbidity and comedication. Further research must be undertaken to ascertain the effect other combinations of chronic diseases have on the efficacy of treatment of this and other diseases.
authors.affiliation: Parasite imunolo-epdemiology group, University of Edinburgh, UK.
authors.forename: Welcome Mkululi
authors.initials: WM
authors.lastname: Wami
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
authors.forename: Stefaan
authors.initials: S
authors.lastname: Bartholomeeusen
authors.forename: Geert
authors.initials: G
authors.lastname: Goderis
authors.forename: Chantal
authors.initials: C
authors.lastname: Mathieu
authors.forename: Marc
authors.initials: M
authors.lastname: Aerts
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000740:Anemia / Q000453:epidemiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D058006:General Practice; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D007592:Joint Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
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