Document Detail

Patient complexity and risk factor control among multimorbid patients with type 2 diabetes: results from the R2D2C2 study.
MedLine Citation:
PMID:  23047130     Owner:  NLM     Status:  MEDLINE    
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: identifier: NCT01123239.
Shaista Malik; John Billimek; Sheldon Greenfield; Dara H Sorkin; Quyen Ngo-Metzger; Sherrie H Kaplan
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical care     Volume:  51     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-21     Completed Date:  2013-03-14     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  180-5     Citation Subset:  IM    
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MeSH Terms
Chi-Square Distribution
Coronary Disease / complications,  prevention & control
Cross-Sectional Studies
Diabetes Mellitus, Type 2 / epidemiology,  ethnology,  prevention & control*
Middle Aged
Patient Compliance*
Primary Health Care
Risk Factors
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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