title: The Effect of Comorbidity on Glycemic Control and Systolic Blood Pressure in Type 2 Diabetes: A Cohort Study with 5 Year Follow-Up in Primary Care.
abstract: OBJECTIVE
  To explore the longitudinal effect of chronic comorbid diseases on glycemic control (HbA1C) and systolic blood pressure (SBP) in type 2 diabetes patients.
  
  
  METHODS
  In a representative primary care cohort of patients with newly diagnosed type 2 diabetes in The Netherlands (n = 610), we tested differences in the five year trend of HbA1C and SBP according to comorbidity profiles. In a mixed model analysis technique we corrected for relevant covariates. Influence of comorbidity (a chronic disease already present when diabetes was diagnosed) was tested as total number of comorbid diseases, and as presence of specific disease groups, i.e. cardiovascular, mental, and musculoskeletal disease, malignancies, and COPD. In subgroup effect analyses we tested if potential differences were modified by age, sex, socioeconomic status, and BMI.
  
  
  RESULTS
  The number of comorbid diseases significantly influenced the SBP trend, with highest values after five years for diabetes patients without comorbidity (p = 0.005). The number of diseases did not influence the HbA1C trend (p = 0.075). Comorbid musculoskeletal disease resulted in lower HbA1C at the time of diabetes diagnosis, but in higher values after five years (p = 0.044). Patients with cardiovascular diseases had sustained elevated levels of SBP (p = 0.014). Effect modification by socioeconomic status was observed in some comorbidity subgroups.
  
  
  CONCLUSIONS
  Presence of comorbidity in type 2 diabetes patients affected the long-term course of HbA1C and SBP in this primary care cohort. Numbers and types of comorbidity showed differential effects: not the simple sum of diseases, but specific types of comorbid disease had a negative influence on long-term diabetes control parameters. The complex interactions between comorbidity, diabetes control and effect modifiers require further investigation and may help to personalize treatment goals.
authors.affiliation: Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Hilde
authors.initials: H
authors.lastname: Luijks
authors.affiliation: Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Marion
authors.initials: M
authors.lastname: Biermans
authors.affiliation: Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Bor
authors.affiliation: Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands; Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.affiliation: Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Toine
authors.initials: T
authors.lastname: Lagro-Janssen
authors.affiliation: Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: de Grauw
authors.affiliation: Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Tjard
authors.initials: T
authors.lastname: Schermer
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin