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

TitleBeyond comorbidity counts: how do comorbidity type and severity influence diabetes patients' treatment priorities and self-management?
Publication TypeJournal Article
Year of Publication2007
AuthorsKerr, EA, Heisler, MM, Krein, SL, Kabeto, MU, Langa, KM, Weir, DR, Piette, JD
JournalJ Gen Intern Med
Date Published2007 Dec
ISSN Number1525-1497
Call Numbernewpubs20090302_Kerr_etal.pdf
KeywordsAged, Attitude to Health, Cohort Studies, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus, Female, Health Priorities, Heart Failure, Humans, Male, Middle Aged, Self Care, Severity of Illness Index, United States

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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Endnote Keywords

diabetes/COMORBIDITY/Chronic Illness

Endnote ID


Alternate JournalJ Gen Intern Med
Citation Key7173
PubMed ID17647065
PubMed Central IDPMC2219819
Grant ListP60DK-20572 / DK / NIDDK NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
K08 AG019180 / AG / NIA NIH HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States
P60 DK020572 / DK / NIDDK NIH HHS / United States
K08 AG19180 / AG / NIA NIH HHS / United States