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Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients' treatment priorities and
Eve A Kerr1, Michele Heisler, Sarah L Krein
1VA HSR&D Center of Excellence, VA Ann Arbor Health Care System, Ann Arbor, MI, USA. ekerr@umich.edu
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.
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