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The Effect of Incident Cancer, Depression and Pulmonary Disease Exacerbations on Type 2 Diabetes Control

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Abstract

Introduction

Little is known about how the development of a new chronic health condition affects management of existing chronic conditions over time. New conditions might worsen management of existing conditions because of competing demands or improve management of existing conditions because of increased engagement with heath care. We assessed the effect of incident stage 0, 1, 2 or 3 breast, colon or prostate cancer; incident depression; or an exacerbation of chronic pulmonary disease on control of type 2 diabetes (DM2).

Methods

We conducted a longitudinal, historical cohort study within an integrated, not-for-profit HMO. Of a cohort of persons with diagnoses of DM2 between 1998 and 2008, 582, 2,959 and 2,332 developed incident cancer, depression or pulmonary disease exacerbation, respectively. We assessed change in hemoglobin A1c (A1c) as a function of the occurrence of the incident comorbidity in each subcohort for a period of 1 to 5 years after the occurrence of the incident comorbidity. Secondary outcomes were systolic blood pressure (SBP) and low density lipoprotein (LDL) levels. Multivariate linear regression was adjusted for demographics, morbidity level, BMI, numbers of primary and specialty visits, and continuity of primary care. Latent class analyses assessed post-comorbidity outcome trajectories. All time-varying covariates were calculated for a 24-month pre-diagnosis period and 0 to 24- and 24 to 60-month post-diagnosis periods.

Results

For each condition, A1c did not change significantly from before to after the incident comorbidity. This was confirmed by latent class growth curve analyses that grouped patients by their A1c trajectories. SBP and LDL were also not significantly changed pre- and post-diagnosis of the incident comorbidities.

Discussion

Although incident comorbidities inevitably will affect patients’ and clinicians’ care priorities, we did not observe changes in these particular outcomes. Additional investigation of interactions between diseases will inform changes in care that benefit complex patient populations.

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Acknowledgements

Supported by the Agency for Healthcare Research and Quality: 1 R21 HS017627-01 and K08 HS015476 (to E.A.B.). This material has not been presented prior to publication. Limited results were presented as a poster presentation to a small group conference at the AHRQ annual conference in September 2010 and at the annual conference of the North American Primary Care Research Group, Seattle, WA, November 2011.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Kaiser Permanente Colorado, Institute for Health Research, 10065 E. Harvard Ave. Ste 300, Denver, CO, 80231, USA

    Elizabeth A. Bayliss MD, MSPH, Sophia R. Newcomer MPH & John F. Steiner MD, MPH

  2. Colorado Health Outcomes Program, University of Colorado Denver, Aurora, CO, USA

    Diane L. Fairclough DrPH

  3. Department of Biometrics, University of Colorado Denver, Aurora, CO, USA

    Patrick J. Blatchford PhD & Diane L. Fairclough DrPH

  4. Department of Family Medicine, University of Colorado Denver, Aurora, CO, USA

    Elizabeth A. Bayliss MD, MSPH

  5. Department of Internal Medicine, University of Colorado Denver, Aurora, CO, USA

    John F. Steiner MD, MPH

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  1. Elizabeth A. Bayliss MD, MSPH
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  2. Patrick J. Blatchford PhD
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Corresponding author

Correspondence to Elizabeth A. Bayliss MD, MSPH.

Appendix

Appendix

Table 3 Adjusted Outcomes of A1c, SBP and LDL as a Function of Each Incident Comorbidity Over Time
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Table 4 Adjusted Models with Covariates: Outcomes as a Function of Incident Comorbidities
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Bayliss, E.A., Blatchford, P.J., Newcomer, S.R. et al. The Effect of Incident Cancer, Depression and Pulmonary Disease Exacerbations on Type 2 Diabetes Control. J GEN INTERN MED 26, 575–581 (2011). https://doi.org/10.1007/s11606-010-1600-x

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  • DOI: https://doi.org/10.1007/s11606-010-1600-x

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