Elsevier

Primary Care Diabetes

Volume 3, Issue 3, August 2009, Pages 141-148
Primary Care Diabetes

Original research
Health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease

https://doi.org/10.1016/j.pcd.2009.06.005Get rights and content

Abstract

Aims

To describe the health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease (COPD), and compare it with that of non-diabetic COPD patients.

Patients and methods

An observational and descriptive epidemiological study (EPIDEPOC study). The study included patients with stable COPD and aged ≥40 years, evaluated in primary care. Data were collected relating to sociodemographic variables, health profile, quality of life (SF-12), treatment and health care resources consumption. The results corresponding to diabetic and non-diabetic patients were compared.

Results

A total of 10,711 patients (75.6% males) with COPD were evaluated. The prevalence of diabetes was 16.9%. The diabetic patients were significantly older, with a larger percentage of women, and a lesser educational level compared with the non-diabetic patients. In addition, the diabetics were more sedentary, smoked less, and presented a higher percentage of obesity (33.6% versus 19.7%) than the non-diabetic patients. The severity of airways obstruction was greater among the diabetics than in the non-diabetic patients (54.57 ± 13.37% versus 57.92 ± 13.39%, respectively, p < 0.05). As to co-morbidity, the diabetics showed a greater frequency of arterial hypertension, hypercholesterolemia, heart disease, depression and anxiety. Both the physical and the mental component as measured by the SF-12 yielded significantly poorer results among the diabetics. On the other hand, the diabetic subjects showed a higher consumption of drugs for COPD. In addition, they consumed significantly more health care (and thus economical) resources than the non-diabetic patients. The results of the multivariate logistic regression analysis showed that the variables that were independently associated to COPD among diabetic patients were: higher age, higher BMI, concomitant chronic heart disease, use of inhaled corticoids, SF-12 mental component, SF-12 physical component and total cost of COPD.

Conclusions

The presence of diabetes in patients with COPD shows in the bivariate analysis a more severe lung disease, greater co-morbidity, poorer quality of life, and a greater consumption of resources, as well as a less favorable course in the previous year. However, the multivariate logistic regression shows that the variables that are independently associated to COPD among diabetic patients are higher age, higher BMI, concomitant chronic heart disease, use of inhaled corticoids, physical and mental component of quality of life questionnaire and total cost of COPD.

Introduction

Chronic obstructive pulmonary disease (COPD) is an important public health problem at precedent, with prevalence, morbidity and mortality rates growing continuously. Coexisting co-morbid diseases impact substantially in the prognosis of disease [1].

The presence of diabetes mellitus is common among patients with chronic obstructive lung disease (COPD) [2]. It has even been demonstrated that women with COPD are at an increased risk of developing type 2 diabetes mellitus than those without COPD [2]. On the other hand, about 15% of all patients admitted to hospital due to acute exacerbation of COPD have a history of diabetes mellitus [3], [4]. The implication of certain proinflammatory cytokines such as C-reactive protein (CRP), interleukin (IL) 6 and tumor necrosis factor (TNF) α in the aetiopathogenesis of both disorders could account for this association [5], [6], [7], [8], [9], [10], [11], [12], [13], [14].

Despite the demonstrated relationship between diabetes mellitus and COPD, very few studies have jointly addressed these two diseases [2], [15], [16]. In addition, no studies have analyzed the characteristics of patients with both diabetes and COPD.

The present study aims to describe the health, treatment and health care resource consumption profile among Spanish adults with diabetes and COPD, and compare it with that of non-diabetic COPD patients.

Section snippets

Subjects and methods

The present study forms part of the EPIDEPOC survey, an observational and descriptive, multicentre epidemiological study conducted in the primary care setting to explore the use of health care resources and assess the quality of life of patients with stable COPD. The detailed methodology and the overall results of the study have been published elsewhere [17], [18].

Briefly, the EPIDEPOC study included patients of both sex and aged over 40 years, with a diagnosis of COPD established at least 12

Results

A total of 10,711 patients (75.6% males) with a mean age of 67.1 ± 9.66 years were evaluated. The prevalence of associated type 2 diabetes was 16.9%. On comparing the sociodemographic parameters of the diabetics versus the non-diabetic subjects, the former were seen to be significantly older, with a larger percentage of women, and a lesser educational level compared with the non-diabetic patients (Table 1).

Table 2 reports the health profile, the severity of airways obstruction according to FEV1,

Discussion

In the present study, COPD patients with associated diabetes were found to be older, with a higher body mass index, increased co-morbidity, more severe airways obstruction, and a poorer quality of life than COPD patients without diabetes, and they moreover consumed more drugs, used more health care resources, and generated higher costs than the latter group of patients. To our knowledge, there are few studies aiming to compare two COPD populations according to the presence or absence of

Conflict of interest

JRG and AMC are employees at Pfizer Spain and EGV is employee at Boehringer Ingelheim SA. The other authors have not any conflict of interest with Pfizer or Boehringer Ingelheim SA. This study has been funded by an unrestricted grant from Pfizer Spain and Boehringer Ingelheim SA.

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