Beyond comorbidity counts: How do comorbidity type and severity influence diabetes patients' treatment priorities and self-management?
Beyond comorbidity counts: How do comorbidity type and severity influence diabetes patients' treatment priorities and self-management?
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DOI：
10.1007/s11606-007-0313-2
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发表时间：
2007-12-01
影响因子：
5.7
通讯作者：
Piette, John D.
中科院分区：
文献类型：
--
作者：
Kerr, Eve A.;Heisler, Michele;Piette, John D.
背景大多数老年人有两种或两种以上的慢性疾病，在糖尿病患者中，40%至少有三种。目的我们试图了解合并症的数量、类型和严重程度如何影响糖尿病患者的自我管理和治疗优先顺序。设计横断面观察研究。PATIENT2003年健康与退休研究(HRS)糖尿病调查的总共1,901名糖尿病患者。测量我们构建了多因素模型来评估合并疾病的存在与两种自我报告结果、糖尿病优先排序和自我管理能力之间的关系，并控制患者的人口统计学。共病的特征是首先统计所有共病情况，然后是特定的共病亚型(微血管、大血管和非糖尿病相关)，最后是1种严重共病的严重程度：心力衰竭(HF)。结果40%的受访者至少有一种微血管共病，79%的受访者至少有一种大血管共病，61%的受访者至少有一种非糖尿病相关的共病。合并症总数越多的患者对糖尿病的优先程度越低，糖尿病自我管理能力得分也越差。然而，只有大血管和非糖尿病相关的并发症，而不是微血管的并存，与较低的糖尿病优先顺序相关，而较多的微血管、大血管和非糖尿病相关疾病与较低的糖尿病自我管理能力得分相关。严重但不轻微的心衰与较低的糖尿病优先顺序和自我管理得分相关。结论影响糖尿病患者自我管理的不仅是合并症的数量，还包括合并症的类型和严重程度。患有严重症状性合并症的患者以及那些他们认为与糖尿病无关的患者在决定护理优先顺序和自我管理活动时可能需要额外的支持。
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.