In addition to increased risk of macrovascular and microvascular complications of diabetes, people with diabetes are at increased risk for many comorbid conditions, including depression, cancer, infectious disease, periodontal disease, liver disease, osteoarthritis, osteoporosis, sleep disorders, cognitive impairment, hearing loss, erectile dysfunction and hypogonadism in men, and urinary incontinence in older adults. Comorbid conditions can worsen diabetes control and outcomes through a variety of mechanisms, including limiting the time and resources available for diabetes care and prevention.
Nearly half of adults with diabetes have diagnosed arthritis, 12 which may limit physical activity. Inflammation associated with periodontal disease can worsen diabetes control, and both diabetes and periodontal disease are associated with increased cardiovascular disease (CVD) risk. Depression, which affects about one-quarter of those with diabetes, also increases the risk for CVD and can impede diabetes self-management. People with diabetes are at increased risk for pneumonia and influenza and have worse outcomes, heightening the importance of preventive vaccination. Hip fracture risk is increased in both type 1 and type 2 diabetes, despite higher bone mineral density in people with type 2 diabetes.
Hearing loss is doubled in adults with diabetes and can impair communication with health care providers. Cognitive impairment is also doubled and may precipitate medication errors and hypoglycemia risk. Severe vision loss is 29 times more common in patients with diabetes and may impose significant obstacles to good self-care. Diabetes is associated with increased risk of cancers of the liver, pancreas, endometrium, colon/rectum, breast, and bladder. 13 Shared risk factors between type 2 diabetes and cancer (obesity and physical inactivity) may contribute to the association, and addressing these risk factors can lower risk for both type 2 diabetes and cancer. 14