Background: Multimorbidity in persons with type 2 diabetes (T2D) has not been studied in population wide settings. We used a Danish nation-wide diabetes register to assess trends in incidence and prevalence of vascular multimorbidity.
Methods: All Danish persons with T2D since 1996 were followed from diagnosis to death or 2020-12-31. Follow-up was classified by the number of vascular morbidities from: atrial fibrillation, heart failure, myocardial infarction, ischemic stroke, hemorragic stroke, transient cerebral ischemia, amputation, retinopathy and nephropathy. Persons could enter with any number of vascular morbidities. We analyzed mortality rates and rates of each additional morbidity, using age, calendar time and number of attained morbidities as predictors. Prevalence of morbidities at diagnosis and at calendar times was modeled by binomial regression.
Results: 505,124 persons entered the study. Occurrence of first morbidity increased mortality by a factor 2. Further morbidities increased mortality by a factor of 1.5. Mortality decreased 4%/year regardless of morbidity status. Incidence of additional morbidities increased only for the first 2 acquired morbidities by factors 1.8 and 1.2 and decreased by 3%/year regardless of morbidity status. The prevalence of morbidities at date of T2D increased until 2015. The prevalence of 1+ morbidity in all persons with T2D increased till 2008 and remained stable at 40% for men and 25% for women at age 65, and for 2+ at 10 and 5%.
Conclusion: The decrease in morbidity and mortality rates is an indication of successful treatment of Danish persons with diabetes with respect to adverse vascular outcomes. This could be the result of earlier diagnosis of T2D; including persons earlier in the course of T2D would result in a “healthier” population. The increase in prevalence of morbidities at T2D diagnosis and the constant prevalence over time among all T2D persons may be an indication that management of morbidities is improving.
B.Carstensen: Stock/Shareholder; Novo Nordisk. K.K.B.Clemmensen: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. V.Kosjerina: Research Support; Sanofi-Aventis Deutschland GmbH. F.Persson: Advisory Panel; AstraZeneca, Bayer Consumer Care AG, Boehringer-Ingelheim, Novo Nordisk A/S, Consultant; AstraZeneca, Boehringer-Ingelheim, Novo Nordisk A/S, Research Support; Boehringer-Ingelheim, Novo Nordisk A/S, Speaker's Bureau; AstraZeneca, Bayer Consumer Care AG, Boehringer-Ingelheim, Novo Nordisk A/S, Sanofi.
