Background: Diabetes mellitus is a chronic metabolic disease with a wide range of complications/co-morbidities.
Systematic assessment of co-morbidity at the population level is needed to monitor
the burden of disease and quality of diabetic care. Methods: Using standardized computer-assisted interview (CATI) technique, GEDA 2009 collected
information on physician-diagnosed diabetes mellitus and 18 other chronic conditions
in a representative sample of 21262 German men and women aged 18 years and older.
Co-morbidity was analysed by conditional count, co-morbid pairs, and multiple logistic
regression. Results: The population-weighted 12-month prevalence of persons with diabetes mellitus was
7.3% (95% CI: 6.8%-7.9%) with no difference between men and women. In both sexes,
the prevalence increased considerably with age, ranging from 0.7% and 1.1% among 18–29
year-old men and women to 18.7% and 17.4% among men and women 65 years and above.
More than 90% of diabetics suffered from any co-morbidity. The average number of comorbidities
(mean±SD) was significantly higher among women than men (4.2±2.6 vs. 3.3±2.3; p<0.001).
The most frequent co-morbidities among diabetics included hypertension (men: 70.4%
vs. women: 69.4%), hyperlipidemia (48.5% vs. 51.4%), osteoarthritis (26.7% vs. 48.7),
hearing impairment (34.6% vs. 37.1%) and chronic back pain (24.9% vs. 39.5%). In multivariable
regression analyses adjusting for age, sex, education, and all other health conditions,
diabetes was independently associated with hypertension (OR: 3.3; 95% CI: 2.9–3.8),
chronic liver disease (2.7; 1.9–3.7) and hyperlipidemia (1.8; 1.6–2.0) in both sexes,
and with chronic renal disease (3.2; 2.2–4.7), rheumatoid arthritis (1.7; 1.3–2.2),
myocardial infarction (1.5;1.1–2.2), cancer (1.4; 1.1–1.8) and depression (1.4; 1.0–1.8)
among women, and with congestive heart failure (1.8; 1.3–2.8) among men. Conclusion: Diabetes-related co-morbidity patterns include complications of diabetes and other
chronic conditions. Sex-specific differences may in part reflect survivorship bias
and deserve further investigation with respect to health care services utilization
and quality of care.
