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J Gen Intern Med. 2007 Dec;22(12):1635-40. Epub 2007 Jul 24.

Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients' treatment priorities and self-management?

Author information

1
VA HSR&D Center of Excellence, VA Ann Arbor Health Care System, Ann Arbor, MI, USA. ekerr@umich.edu

Abstract

BACKGROUND:

The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40% have at least three.

OBJECTIVE:

We sought to understand how the number, type, and severity of comorbidities influence diabetes patients' self-management and treatment priorities.

DESIGN:

Cross-sectional observation study.

PATIENTS:

A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey.

MEASUREMENTS:

We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF).

RESULTS:

40% of respondents had at least 1 microvascular comorbidity, 79% at least 1 macrovascular comorbidity, and 61% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores.

CONCLUSIONS:

The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients' self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.

PMID:
17647065
PMCID:
PMC2219819
DOI:
10.1007/s11606-007-0313-2
[Indexed for MEDLINE]
Free PMC Article

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