Diabetes accelerates the onset of solemn, chronic diseases by 15–20 years, shortening life expectancy

In a recent study published in the journal natural medicine, Researchers in the United Kingdom (UK) estimated the age of onset, years spent, and life lost to diabetes-related multidrug-resistant chronic conditions (MLTC) among 46 million English adults. They found that diabetes accelerates the onset of severe MLTC by 15–20 years, significantly shortens life expectancy, and has different effects on different age groups. While hypertension, cancer, depression, and coronary artery disease were found to be major contributors to disease in older adults, mental health disorders and asthma were found to be significant in younger adults.

Test: The burden of multiple chronic conditions associated with diabetes that impact years of life spent and lost. Photo Source: Ground Picture / Shutterstock

Background

Type 2 diabetes is a major contributor to various forms of morbidity due to insulin resistance, chronic hyperglycemia and related dysfunctions. It is strongly associated with both microvascular and macrovascular complications, including cardiovascular, eye, foot and kidney disease. Although guidelines and preventive measures have reduced these complications, diabetes also increases the risk of diseases such as cancer, respiratory diseases, infections, liver disease and dementia. These conditions are becoming increasingly common due to factors such as increasing life expectancy and obesity, shifting the burden of complications to younger adults and from cardiovascular to non-cardiovascular diseases, leading to an enhance in the incidence of MLTC. The healthcare system, particularly in England, faces challenges in managing the increasing burden of MLTC, which impacts on clinical care, costs and quality of life. Current indicators do not adequately capture the diversity and severity of MLTC, highlighting the need for better quantification of years spent and life shortened due to these conditions. Improved indicators can lend a hand understand modifiable risk factors and inform healthcare responses and strategies to prevent MLTC. Therefore, researchers in this study examined the burden of diabetes-related MLTC in adults in England, using a comprehensive dataset to develop fresh indicators.

About the study

The study used the National Bridges to Health Segmentation Dataset, which contains data from people registered with a general practitioner (GP) in England since 2014. A total of 46,748,714 adults aged 20 years and over were included in the study. To avoid confounding due to the coronavirus disease 2019 (COVID-19) pandemic, data from April 2019 to March 2020 were included. In addition, data on socio-demographics, geography and clinical diagnoses for 35 chronic medical conditions were included. Conditions were defined using extensive clinical review and established coding systems such as the International Classification of Diseases (ICD)-10, Office of Population Censuses and Surveys (OPCS) and Systematized Medical Nomenclature for Medicine–Clinical Terminology (SNOMED CT).

The prevalence of diabetes with MLTC was estimated. A three-state Markov disease-death model was then used to estimate the number of years people spend with and lose to these conditions. Key indicators were identified, including lifetime risk, median age at onset, number of years lived with these conditions, age at death, and number of years of life lost, taking into account both individual and community perspectives.

Results and discussion

Of all study participants, 7.8% were diagnosed with diabetes. Adults with diabetes had a higher prevalence of MLTC than those without diabetes. By age 50, about one third of adults with diabetes had at least three MLTC, a prevalence that was not reached in the general population until age 65–70. Common comorbidities included hypertension, coronary heart disease (CHD), osteoarthritis, depression, and asthma, and their prevalence varied by age and sex. For example, older adults were more likely to have hypertension and CHD, whereas younger adults were more likely to have depression and asthma.

The median age at onset of at least two conditions was 66–67 years, with those with more conditions having earlier death and fewer years with MLTC. Younger adults with MLTC had a greater impact on years of life lost and lost. For diabetes-related comorbidities, classic renovascular complications showed a later onset and fewer years of life lost, while psychiatric conditions and asthma showed an earlier onset and longer life with these conditions. In addition, the impact at the community level was highlighted, with hypertension, depression, osteoarthritis, asthma, and CHD accounting for a significant burden. Men experienced more years of life lost due to hypertension and CHD, while women were more affected by depression.

The study is strengthened by its comprehensive coverage of over 98% of the English population registered with a GP, providing highly representative data on diabetes-related MLTC and quantifying the burden at both individual and community levels. However, the study is circumscribed by potential underestimation from hospital/community datasets, exclusion of some conditions, inability to distinguish between types of diabetes and focus on 35 priority conditions, which may lead to conservative estimates of metrics.

Application

In conclusion, this study highlights the extensive burden of diabetes-related MLTC, considering both individual and community perspectives. The results support improved health resource allocation and commissioning decisions, emphasizing the need for pioneering strategies to prevent and treat MLTC.