Medical College of Wisconsin
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Multiple chronic conditions in type 2 diabetes mellitus: prevalence and consequences. Am J Manag Care 2015 Jan 01;21(1):e23-34

Date

04/17/2015

Pubmed ID

25880265

Abstract

OBJECTIVES: Multiple chronic comorbidities (MCCs) are an issue of growing significance in diabetes because they are highly prevalent and can increase disease burden and costs. We examined MCC patterns among patients with type 2 diabetes mellitus and identified specific comorbidity clusters associated with poor patient outcomes.

STUDY DESIGN AND METHODS: We conducted a cross-sectional analysis of 161,174 patients with diabetes using electronic health record data supplied by US providers in the 2008 to 2012 Humedica data sets. We examined prevalence of MCC clusters in younger and older patients. For each of the 15 most common MCC clusters, we reported predicted probabilities for diabetes face-to-face visits, reaching glycated hemoglobin < 8%; emergency department (ED) visits; and 30-day hospital readmissions, based on logistic regression results.

RESULTS: The leading MCC combination was the presence of hypertension-hyperlipidemia-obesity and no other diagnosed comorbidities (19% of the sample). The most notable difference, by age, was a higher prevalence of obesity in the younger cohort. MCC clusters were more diverse among the older population: the top 10 MCC clusters accounted for 66% of older patients, compared with 78% of younger patients. Patients with certain comorbidity profiles, such as those with obesity only, were less likely to have diabetes-related face-to-face visits and to meet A1C treatment goals, and more likely to have ED visits and 30-day readmissions.

CONCLUSIONS: Patients with diabetes have substantial comorbidities, but the patterns vary considerably across patients and by age. Diabetes care remained suboptimal among many types of MCC patients, and patient outcomes varied by MCC profile. Specific management strategies should be developed for common MCC clusters, such as hypertension-hyperlipidemia-obesity.

Author List

Lin PJ, Kent DM, Winn A, Cohen JT, Neumann PJ

Author

Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Chronic Disease
Cluster Analysis
Comorbidity
Databases, Factual
Diabetes Mellitus, Type 2
Female
Hospitalization
Humans
Hyperlipidemias
Hypertension
Logistic Models
Male
Middle Aged
Obesity
Patient Readmission
Prevalence
Prognosis
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Analysis
jenkins-FCD Prod-400 0f9a74600e4e79798f8fa6f545ea115f3dd948b2