<p>The role of concordant and discordant comorbidities on performance of self-care behaviors in adults with type 2 diabetes: a systematic review</p>

Abstract

Background: Most patients with Type 2 diabetes (T2D) have high number of comorbid chronic conditions that can affect their self-care abilities. Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities. Identifying comorbidities that either improve or potentially diminish the individual’s capacity to perform effective self-care behaviors is essential to enhance clinical outcomes. One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals. Objective: The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D. Methods: A comprehensive literature search was undertaken to identify published English language articles through the following five electronic databases: PubMed, CINAHL, PsycINFO, ISI Web of Science, and EMBASE. Quantitative studies published from March 2006 to April 2018 were included. Quality of evidence was evaluated using the Joanna Briggs Institutes Critical Appraisal Tools (JBI-CAT) and rated using Quality Assessment Tool for Quantitative Studies (QATQS). Results: The initial database search identified 1,136 articles but only 33 studies that met the inclusion criteria were included. The most common concordant comorbidity was hypertension while depression was the most common discordant condition. Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities. The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension, hyperlipidemia, retinopathy, and heart failure on diabetes self-care behaviors. But, there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors. Conclusions: Concordant comorbidities may improve diabetes self-care, but the evidence is inconclusive. Future research using well designed studies are needed to examine the complex relationship between diabetes self-care and comorbidities.

The Probability of A1C Goal Attainment in Patients With Uncontrolled Type 2 Diabetes in a Large Integrated Delivery System: A Prediction Model

“…The prevalence of depression was close to 30% in this study cohort, similar to that reported elsewhere for populations with T2D ( 29 – 31 ). Depression has been shown to have a negative impact on diabetes self-care behaviors in general ( 32 – 34 ), although not all analyses have found this ( 29 ). In our study, neither the prevalence of depression nor other psychiatric disease were different between the A1C attainment cohorts.…”

Diabetes Concordant Comorbidities and Associated Factors Among Adult Diabetic Out-Patients at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: a Cross-Sectional Study

“…9 Thus, hypertension, obesity, hyperlipidemia, Chronic Vascular Disease (CVD), and Chronic Kidney Disease (CKD) are commonly reported comorbidities among diabetic patients. [10][11][12][13][14] Furthermore, the studies identified that most adults with diabetes have at least one comorbidity and as many as 40% of them have at least three comorbidities. 15 According to the study conducted among more than 1.3 million participants, more than 97.5% of patients had at least one comorbid condition.…”

Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients

“…They developed a framework in which chronic conditions are conceptualized as concordant (pathophysiologic profile or management plan similar to T2DM) or discordant (pathophysiologic condition and disease-management plan not directly related to T2DM). With the increasing burden of T2DM comorbidity, the aforementioned framework has served as a basis to improve T2DM management and to study the impact of multimorbidity ( Calderón-Larrañaga et al, 2014 ; Lin et al, 2018 ; Aga et al, 2019 ). Indeed, a recent study in Spain demonstrated that the coexistence of mental and other discordant comorbidities in T2DM patients may increase the use of healthcare resources significantly ( Calderón-Larrañaga et al, 2015 ).…”