Patient complexity and risk factor control among multimorbid patients with type 2 diabetes: results from the R2D2C2 study

Abstract

Background: Among patients with type 2 diabetes, it is not known whether risk factor control is better or worse for those who also have heart disease, depression, multiple other comorbidities, and associated management challenges.

Objective: To examine the relationship between this complex constellation of multimorbidities, adherence to treatment and risk factor control among patients with type 2 diabetes, independent of regimen intensity.

Research design: Observational cross-sectional study.

Subjects: A total of 1314 patients with diabetes from the Reducing Racial Disparities in Diabetes Coached Care (R2D2C2) Study.

Measures: A composite cardiometabolic risk factor profile was the dependent variable. Independent variables included a composite measure of patient complexity, patient-reported adherence to treatment, history of coronary heart disease (CHD), and intensity of medication regimen.

Results: A higher proportion of the most complex patient-reported problems with adherence compared with the least complex patients (83.5% vs. 43.3%, P<0.001). Compared with those without a history of CHD, fewer patients with CHD-reported problems with medication adherence (59.3% vs. 69.3%, P<0.01) and had better risk factor control, independent of complexity and regimen intensity. Better risk factor control was independently associated with less patient complexity (P=0.003) and to history of CHD (P=0.01).

Conclusions: The presence of a complex illness profile was associated with poorer control of risk factors. Those with CHD were more adherent to treatment and had better risk factor control. The occurrence of CHD may present an opportunity for physicians to emphasize risk factor management. Diabetes patients with a complex illness profile may be at highest risk for cardiovascular events and in greatest need of prevention of cardiac disease.

Trial registration: Clinicaltrial.gov identifier: NCT01123239.

Figures

Figure 1

Cardiometabolic Risk Management Profile (CRMP) scores, by level of patient complexity1 and history of coronary heart disease (CHD) 1Measured using the 51-item Potential for Benefit Scale (PBS); categories reflect lowest quartile (low), middle 50% (moderate) and highest quartile (high).

Figure 2

Comparison of proportion of patients reporting problems with adherence, by level of patient complexity1 and by history of CHD (n=1314) 1 Measured using the 51-item Potential for Benefit Scale (PBS); categories reflect lowest quartile (low), middle 50% (moderate) and highest quartile (high).