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. 2007 Dec;22(12):1635-40.
doi: 10.1007/s11606-007-0313-2. Epub 2007 Jul 24.

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

Eve A Kerr  1 , Michele Heisler, Sarah L Krein, Mohammed Kabeto, Kenneth M Langa, David Weir, John D Piette
Affiliations

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

Eve A Kerr et al. J Gen Intern Med. 2007 Dec.

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.

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References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/archinte.162.20.2269', 'is_inner': False, 'url': 'https://doi.org/10.1001/archinte.162.20.2269'}, {'type': 'PubMed', 'value': '12418941', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12418941/'}]}
    2. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 2002;162(20):2269–76. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '15623407', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15623407/'}]}
    2. Russell LB, Suh DC, Safford MA. Time requirements for diabetes self-management: too much for many? J Fam Pract 2005;54(1):52–6. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1377/hlthaff.20.6.233', 'is_inner': False, 'url': 'https://doi.org/10.1377/hlthaff.20.6.233'}, {'type': 'PubMed', 'value': '11816664', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11816664/'}]}
    2. Druss BG, Marcus SC, Olfson M, Tanielian T, Elinson L, Pincus HA. Comparing the national economic burden of five chronic conditions. Health Aff 2001;20(6):233–41. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1056/NEJMsb042458', 'is_inner': False, 'url': 'https://doi.org/10.1056/nejmsb042458'}, {'type': 'PubMed', 'value': '15625341', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15625341/'}]}
    2. Tinetti ME, Bogardus ST Jr, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. New Engl J Med 2004;351(27):2870–4. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.294.6.716', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.294.6.716'}, {'type': 'PubMed', 'value': '16091574', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16091574/'}]}
    2. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005;294(6):716–24. - PubMed

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