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      Impact of multimorbidity count on all-cause mortality and glycaemic outcomes in people with type 2 diabetes: a systematic review protocol

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          Abstract

          Introduction

          Type 2 diabetes (T2D) is a leading health priority worldwide. Multimorbidity (MM) is a term describing the co-occurrence of two or more chronic diseases or conditions. The majority of people living with T2D have MM. The relationship between MM and mortality and glycaemia in people with T2D is not clear.

          Methods and analysis

          Medline, Embase, Cumulative Index of Nursing and Allied Health Complete, The Cochrane Library, and SCOPUS will be searched with a prespecified search strategy. The searches will be limited to quantitative empirical studies in English with no restriction on publication date. One reviewer will perform title screening and two review authors will independently screen the abstract and full texts using Covidence software, with disagreements adjudicated by a third reviewer. Data will be extracted using a using a Population, Exposure, Comparator and Outcomes framework. Two reviewers will independently extract data and undertake the risk of bias (quality) assessment. Disagreements will be resolved by consensus. A narrative synthesis of the results will be conducted and meta-analysis considered if appropriate. Quality appraisal will be undertaken using the Newcastle-Ottawa quality assessment scale and the quality of the cumulative evidence of the included studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. This protocol was prepared in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines to ensure the quality of our review.

          Ethics and dissemination

          This review will synthesise the existing evidence about the impact of MM on mortality and glycaemic outcomes in people living with T2D and increase our understanding of this subject and will inform future practice and policy. Findings will be disseminated via conference presentations, social media and peer-reviewed publication.

          PROSPERO registration number

          CRD42017079500.

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          Multimorbidity is common to family practice: is it commonly researched?

          Alain Vanasse, Lise Lapointe, Martin Fortin … (2005)
          Family physicians often have to care for patients with several concurrent chronic conditions (multimorbidity or comorbidity). Consequently, they need to inform themselves by reading indexed publications on multimorbidity. This study aimed to assess how well the concept of multimorbidity was covered in the medical literature. Objectives were first, to quantify the literature on multimorbidity (or comorbidity) and to compare the number of publications on it with the number of publications on three common chronic conditions (asthma, hypertension, and diabetes), and second, to describe the articles on multimorbidity. Bibliometric study. We consulted MEDLINE for the reference period 1990 to the end of 2002. The term "multimorbidity" and its various spellings was used as the search term. Comorbidity, asthma, hypertension, and diabetes were searched for using their respective MeSH terms. For comparison purposes, prevalence data were taken from published sources. Abstracts of articles relating to multimorbidity were reviewed and their content analyzed. Number and type of articles. Multimorbidity has a prevalence of 60% among people aged 55 to 74. This prevalence is much higher than that of asthma (6.5%), hypertension (29.6%), and diabetes (8.7%). Few articles in the medical literature deal specifically with multimorbidity (or comorbidity), however. For each article on multimorbidity, there are 74 on asthma, 94 on hypertension, and 38 on diabetes. Content analysis of abstracts of articles on multimorbidity revealed a high proportion of epidemiologic studies (50.0%) followed by validation studies (22.4%) and opinion pieces (11.8%). The few experimental studies on multimorbidity were not done in primary care settings. This study shows that the prevalence of multimorbidity is not matched by the number of indexed publications on it in the medical literature. To date, the number and diversity of articles on multimorbidity are both insufficient to provide scientific background for strong evidence-based care of patients affected by multiple concurrent chronic conditions. Research is needed to increase knowledge and understanding of this important clinical topic.
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            The prevalence of diagnosed chronic conditions and multimorbidity in Australia: A method for estimating population prevalence from general practice patient encounter data

            Christopher Harrison, Joan Henderson, Graeme Miller … (2017)
            Objectives To estimate the prevalence of common chronic conditions and multimorbidity among patients at GP encounters and among people in the Australian population. To assess the extent to which use of each individual patient’s GP attendance over the previous year, instead of the average for their age-sex group, affects the precision of national population prevalence estimates of diagnosed chronic conditions. Design, setting and participants A sub-study (between November 2012 and March 2016) of the Bettering the Evaluation and Care of Health program, a continuous national study of GP activity. Each of 1,449 GPs provided data for about 30 consecutive patients (total 43,501) indicating for each, number of GP attendances in previous year and all diagnosed chronic conditions, using their knowledge of the patient, patient self-report, and patient's health record. Results Hypertension (26.5%) was the most prevalent diagnosed chronic condition among patients surveyed, followed by osteoarthritis (22.7%), hyperlipidaemia (16.6%), depression (16.3%), anxiety (11.9%), gastroesophageal reflux disease (GORD) (11.3%), chronic back pain (9.7%) and Type 2 diabetes (9.6%). After adjustment, we estimated population prevalence of hypertension as 12.4%, 9.5% osteoarthritis, 8.2% hyperlipidaemia, 8.0% depression, 5.8% anxiety and 5.2% asthma. Estimates were significantly lower than those derived using the previous method. About half (51.6%) the patients at GP encounters had two or more diagnosed chronic conditions and over one third (37.4%) had three or more. Population estimates were: 25.7% had two or more diagnosed chronic conditions and 15.8% had three or more. Conclusions Of the three approaches we have tested to date, this study provides the most accurate method for estimation of population prevalence of chronic conditions using the GP as an expert interviewer, by adjusting for each patient’s reported attendance.
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              Multimorbidity: negotiating priorities and making progress.

              Mark Harris, Sarah Dennis, Megan Pillay (2013)
              Patients with multimorbidity are increasingly common in general practice. Multimorbidity is a challenge for both patients and practitioners because of the complexity of care and its impact on patients' lives. Single-disease-based guidelines are of limited use to providers managing patients with multimorbidity.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2018
                Publication date (Electronic): 5 April 2018
                Volume: 8
                Issue: 4
                Electronic Location Identifier: e021100
                Affiliations
                [1 ] departmentDepartment of General Practice , University of Melbourne , Melbourne, Victoria, Australia
                [2 ] departmentGeneral Practice and Primary Care, Institute of Health and Wellbeing , University of Glasgow , Glasgow, UK
                [3 ] departmentNHMRC Clinical Trials Centre , University of Sydney , Sydney, New South Wales, Australia
                [4 ] departmentBrownless Biomedical Library , University of Melbourne , Melbourne, Victoria, Australia
                [5 ] departmentDepartment of Medicine , St Vincent’s Hospital, University of Melbourne , Melbourne, Victoria, Australia
                Author notes
                [Correspondence to ] Jason I Chiang; jason.chiang@ 123456unimelb.edu.au
                Author information
                http://orcid.org/0000-0002-4370-8063
                http://orcid.org/0000-0003-0339-5848
                http://orcid.org/0000-0002-0870-4032
                Article
                Publisher ID: bmjopen-2017-021100
                DOI: 10.1136/bmjopen-2017-021100
                PMC ID: 5892751
                PubMed ID: 29626050
                SO-VID: 45ae54f2-461b-453a-ae0b-7fac2972bb5a
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 11 December 2017
                Date revision received : 15 March 2018
                Date accepted : 20 March 2018
                Categories
                Subject: Diabetes and Endocrinology
                Subject: Protocol
                Subject: 1506
                Subject: 1843
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: type 2 diabetes,multimorbidity,mortality,glycaemia
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: type 2 diabetes, multimorbidity, mortality, glycaemia

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