MULTIMORBIDTY AND FIVE-YEAR TREND IN DIABETES CARE MANAGEMENT (DCM) AMONG ADULTS WITH DIABETES

OBJECTIVES : A high prevalence of multimorbidity (co-occurrence of more than one chronic condition, excluding diabetes) is reported in adults with diabetes. Multimorbidity can negatively affect DCM due to competing demands and prioritization of clinical management. The objective of this study is to examine the associations of multimorbidity to DCM and assess changes in DCM over a five-year period.

METHODS : We used a pooled cross-sectional design with two independent cross-sections (2011 and 2015) of the Medical Expenditure Panel Survey, representative of the noninstitutionalized population in the US. Adults (age > 18 years) with professional diagnosed diabetes and who completed Diabetes Care Survey (DCS) (N= 4,291; N 2011 = 2,116; N 2015 = 2,175) were included. DCS is a self-administered paper-based survey that queried DCM practices in the last 12 months (HbA1c test, blood cholesterol test, feet checked for soreness and irritation, dilated-pupil eye-examination, and flu vaccination). Unadjusted, adjusted, and stratified logistic regressions were used to achieve the study objectives. Adjusted analyses controlled for biological, socio-economic, healthcare access, health status, and behavioral characteristics. All analyses accounted for the complex survey design.

RESULTS : 85.1% reported multimorbidity; adults with multimorbidity had poor physical, mental health, had higher rates of chronic pain, obesity, and physical inactivity. Adjusted analyses indicated that adults with multimorbidity were more likely to participate in all DCM recommendations except foot examination (example: HbA1c AOR = 1.68, 95% CI: 1.26, 2.24; Cholesterol level AOR = 1.71, 95% CI: 1.21, 2.41) compared to those without multimorbidity. Trend analysis showed no statistically significant differences in the DCM patterns for those with multimorbidity.

CONCLUSIONS : Eight in 10 adults with diabetes reported multimorbidity. Those with multimorbidity were more likely to receive recommended DCM services, which can be explained by “the surveillance hypothesis" (i.e. more likely to access health services).