New real-world evidence study highlights the need to personalize the care of people with Type 2 diabetes

Real-world evidence study identifies the wide variation in comorbidities among people with Type 2 diabetes mellitus across subgroups and over the course of their disease, highlighting the need to personalize their care pathways.

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Recently published in eClinicalMedicine, a new study using real-world data (RWD) from a UK primary care database has examined 35 comorbidities present in individuals diagnosed with Type 2 diabetes mellitus (T2DM), including both traditional and emerging T2DM conditions, to determine their prevalence at diagnosis, over time and in different subgroups. Their findings highlight the extent and range of comorbidities present in this population, and the urgent need for personalized care and prevention measures.

Researchers from several institutions, including Imperial College London (UK), the Royal College of Surgeons of Ireland and the National Institute for Health and Care Excellence (UK), examined RWD from more than 200,000 people diagnosed with T2DM from the Discover-NOW dataset – a primary care database from 2000 to 2020 including 2.5 million people across north-west London, UK.

Their findings highlighted the “extent and breadth of morbidity” in their study population, with multimorbidity (the presence of two or more chronic conditions) common. Nearly 30% of people in the study had three or more comorbidities at diagnosis, and this increased to 60% ten years after diagnosis.

The types of comorbidities themselves varied considerably, with nine found to be the most common, with a prevalence of over 3% (hypertension, back pain, retinopathy, depression, osteoarthritis, ischemic heart disease, acute myocardial infarction, asthma and renal disease).

Interestingly, although some comorbidities highlighted in the study were conditions commonly associated with T2DM, such as hypertension, retinopathy and ischemic heart disease, some were more unexpected and not routinely included in guidelines for the management of these patients. For example, back pain, depression and osteoarthritis were all identified by the study authors as being common in people with T2DM in the last 10 years of the study period.

The most common comorbidities also varied by ethnicity, for example with hypothyroidism twice as prevalent in Asian people compared with black people; and sex, for example, with prevalence higher for conditions such as ischemic heart disease in men and hypothyroidism in women.

The authors findings highlight the value of RWD of this kind, and suggest that a personalized approach to healthcare is urgently needed for people with T2DM, to address their individual care needs throughout the course of the disease, and to ensure that appropriate preventative measures are put in place.

Co-author Páll Jónsson, Programme Director for Data and RWE at NICE, added: “Around one in ten people over 40 in the UK are now living with a diagnosis of Type 2 diabetes and that number is projected to rise to over 5 million by 2030. Until now there has been limited research on the impact of multi and co-morbidities across different patient groups and how this progresses during the course of the disease. This study has highlighted the large variations in clinical need within the patient group. The work is also showing us how the rich clinical data that reflects patients in practice – the real world data – can stimulate new research questions and can help inform future developments of clinical guidelines.”