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Background <p>Multimorbidity with diabetes mellitus (DM and ≥ 1 chronic disease) presents challenges to maintaining adequate DM control.</p> Objective <p>This study evaluates the risk of DM-related complications associated with various multimorbidity/DM patterns for patients seen in community-based health centers (CHCs).</p> Design <p>Retrospective cohort study from the ADVANCE multi-state practice-based clinical data network.</p> Participants <p>Study included data from 132,765 patients age ≥ 45&#xa0;years with DM seen in 2493 CHCs across 26 states from 10/01/2015 to 12/31/2019.</p> Main Measures <p>We assessed accrual of conditions and risk of experiencing DM complications during follow-up. Primary outcome of DM complication was categorized into acute, microvascular, microvascular (end-stage), macrovascular, or other. Key exposures included mutually exclusive multimorbidity categories: (1) DM + cardiometabolic, (2) DM + other somatic, (3) DM + mental, (4) DM + mental + somatic.</p> Key Results <p>At baseline, 17.2% of patients had DM only, 55.0% had DM + cardiometabolic multimorbidity, 2.3% had DM + other somatic multimorbidity, 3.0% had DM + mental multimorbidity, and 22.5% had DM + mental + somatic multimorbidity. Most DM-only patients (76.5%) developed multimorbidity with DM by study end. Compared with DM-only, adjusted risk differences of DM complications ranged from 1.4% (acute) to 8.8% (microvascular). DM + mental + somatic multimorbidity was associated with 13.4% (95%CI 12.8–14.1%) higher adjusted risk of experiencing any DM complication.</p> Conclusions <p>CHCs care for increasingly complex populations of patients with DM. Tailoring disease management strategies to address comorbid cardiovascular and/or mental health conditions may be important to prevent acute, microvascular, and macrovascular complications in these settings.</p>

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Diabetes Complications Among Community-Based Health Center Patients with Varying Multimorbidity Patterns

  • 期刊论文

  • 发表日期：

    2025年3月4日

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  • Ana R. Quiñones,
  • Jun Hwang,
  • Nathalie Huguet,
  • Charisse Madlock-Brown,
  • Miguel Marino,
  • Robert Voss,
  • Charles Garven,
  • David A. Dorr

摘要

Background

Multimorbidity with diabetes mellitus (DM and ≥ 1 chronic disease) presents challenges to maintaining adequate DM control.

Objective

This study evaluates the risk of DM-related complications associated with various multimorbidity/DM patterns for patients seen in community-based health centers (CHCs).

Design

Retrospective cohort study from the ADVANCE multi-state practice-based clinical data network.

Participants

Study included data from 132,765 patients age ≥ 45 years with DM seen in 2493 CHCs across 26 states from 10/01/2015 to 12/31/2019.

Main Measures

We assessed accrual of conditions and risk of experiencing DM complications during follow-up. Primary outcome of DM complication was categorized into acute, microvascular, microvascular (end-stage), macrovascular, or other. Key exposures included mutually exclusive multimorbidity categories: (1) DM + cardiometabolic, (2) DM + other somatic, (3) DM + mental, (4) DM + mental + somatic.

Key Results

At baseline, 17.2% of patients had DM only, 55.0% had DM + cardiometabolic multimorbidity, 2.3% had DM + other somatic multimorbidity, 3.0% had DM + mental multimorbidity, and 22.5% had DM + mental + somatic multimorbidity. Most DM-only patients (76.5%) developed multimorbidity with DM by study end. Compared with DM-only, adjusted risk differences of DM complications ranged from 1.4% (acute) to 8.8% (microvascular). DM + mental + somatic multimorbidity was associated with 13.4% (95%CI 12.8–14.1%) higher adjusted risk of experiencing any DM complication.

Conclusions

CHCs care for increasingly complex populations of patients with DM. Tailoring disease management strategies to address comorbid cardiovascular and/or mental health conditions may be important to prevent acute, microvascular, and macrovascular complications in these settings.