Polymorbidity in diabetes in older people: consequences for care and vocational training

Abstract

Objective: To investigate the prevalence of complicating and concurrent morbidities in older diabetic patients and to evaluate to what extent their occurrence affects the burden of disease and use of medical healthcare. Study design: Cross-sectional analysis of retrospectively obtained data on comorbidities and use of medical healthcare. Healthcare registration systems were used to retrieve data on 300 patients with diabetes aged >60 years who, according to the severity of their disease and intensity of care required, were treated in a regional general practitioner (GP), diabetes nurse specialist (DNS) or medical specialist (MS) practice. Results: Complicating and concurrent morbidities were often found irrespective of the type of practice involved. After adjustments for differences in sex, age and glycosylated haemoglobin (HbA1c), the extent of complicating comorbidities showed sequential increases in patients managed by GP, DNS and MS (mean number of 3.6, 4.7 and 6.7, respectively; p trend ,0.001). However, the mean number of concurrent comorbidities was similar across all three settings (2.1, 1.8 and 2.0, respectively). Both complicating and concurrent comorbidities were similarly associated with the extent of drug use (b = 0.49 (95% CI 0.40 to 0.58) and b = 0.57 (95% CI 0.52 to 0.72), respectively) and the number of consultations with specialists other than the main care giver (b = 1.19 (95% CI 1.15 to 1.24) and b = 1.21 (95% CI 1.14 to 1.28), respectively). However, the mean number of different specialists involved in a patient's care per additional concurrent comorbidity was twice as high as per any additional complicating comorbidity (b = 0.60 (95% CI 0.48 to 0.71) vs b = 0.31 (95% CI 0.24 to 0.39)). Conclusions: The use of healthcare facilities by older patients with diabetes is substantial, irrespective of the complexity of the disease and the kind of practice involved. The common manifestation of complicating and concurrent comorbidities and their varying complexity in individual patients requires a patient-oriented rather than a disease-oriented approach and vocational training programmes for care givers that are tailored to the complexity of multiple chronic diseases.

Profiling Patients’ Healthcare Needs to Support Integrated, Person-Centered Models for Long-Term Disease Management (Profile): Research Design

“…First, because it is a priority health problem in the Netherlands, focusing on diabetes enables us to capitalise on the full potential that so-called ‘big data’ in electronic diabetes registries offer for personalising care [ 17 ]. Second, type 2 diabetes is widely considered to be a good model for chronic disease in general, in particular given its strong association with comorbidities [ 9 16 ], and is used as such in many countries’ health policymaking efforts in chronic care, including in the Netherlands [ 18 57 ]. Another limitation concerns the setting of the study in primary care, which leads to exclusion of the 10 to 15% most complex cases of type 2 diabetes – i.e.…”

“…For the growing group of patients living with a complex of (interrelated) chronic conditions – such as diabetes, cardiovascular disease, asthma and dementia – disease management means having several care teams working according to different guidelines [ 10 ]. This may lead to fragmented care, loss of responsibility among providers, and confusion or even harm for patients [ 9 ]. Recent studies of chronic care in Europe also point to overstandardised service provision, limited preventive action, and a lack of support for patients’ self-management [ 4 10 11 ].…”