Lin Pei-Jung, Kent David M, Winn Aaron, Cohen Joshua T, Neumann Peter J
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 63, Boston, MA 02111. E-mail:
Am J Manag Care. 2015 Jan 1;21(1):e23-34.
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.
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.
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.
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.
多种慢性合并症（MCCs）在糖尿病中是一个日益重要的问题，因为它们非常普遍，会增加疾病负担和成本。我们研究了2型糖尿病患者中的MCC模式，并确定了与患者不良预后相关的特定合并症集群。
我们使用2008年至2012年Humedica数据集中美国医疗机构提供的电子健康记录数据，对161,174例糖尿病患者进行了横断面分析。我们研究了年轻和老年患者中MCC集群的患病率。对于15个最常见的MCC集群中的每一个，我们根据逻辑回归结果报告了糖尿病面对面就诊、糖化血红蛋白<8%、急诊科（ED）就诊以及30天内再次入院的预测概率。
主要的MCC组合是同时存在高血压、高脂血症和肥胖且无其他已诊断合并症（占样本的19%）。按年龄划分，最显著的差异是年轻队列中肥胖的患病率更高。老年人群中的MCC集群更为多样：前10个MCC集群占老年患者的66%，而年轻患者为78%。具有某些合并症特征的患者，如仅患有肥胖症的患者，进行糖尿病相关面对面就诊和达到糖化血红蛋白治疗目标的可能性较小，而急诊科就诊和30天内再次入院的可能性较大。
糖尿病患者存在大量合并症，但模式因患者个体和年龄差异很大。许多类型的MCC患者的糖尿病护理仍未达到最佳水平，且患者预后因MCC特征而异。应针对常见的MCC集群，如高血压 - 高脂血症 - 肥胖，制定具体的管理策略。
