| Prioritization of care in adults with diabetes and comorbidity. | |
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MedLine Citation:
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PMID: 22211894 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Approximately half of adults with diabetes have at least one comorbid condition. However, diabetes care guidelines focus on diabetes-specific care, and their recommendations may not be appropriate for many patients with diabetes and comorbidity. We describe Piette and Kerr's typology of comorbid conditions, which categorizes conditions based on if they are clinically dominant (eclipse diabetes management), symptomatic versus asymptomatic, and concordant (similar pathophysiologic processes as diabetes) versus discordant. We integrate this typology with clinical evidence and shared decision-making methods to create an algorithmic approach to prioritizing care in patients with diabetes and comorbidity. Initial steps are determining the patient's goals of care and preferences for treatment, whether there is a clinically dominant condition or inadequately treated symptomatic condition, and the risk of cardiovascular disease. With these data in hand, the clinician and patient prioritize diabetes treatments during a shared decision-making process. These steps should be repeated, especially when the patient's clinical status changes. This patient-centered process emphasizes overall quality of life and functioning rather than a narrow focus on diabetes. |
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Authors:
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Neda Laiteerapong; Elbert S Huang; Marshall H Chin |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Review |
Journal Detail:
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Title: Annals of the New York Academy of Sciences Volume: 1243 ISSN: 1749-6632 ISO Abbreviation: Ann. N. Y. Acad. Sci. Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2012-01-03 Completed Date: 2012-02-16 Revised Date: 2012-03-07 |
Medline Journal Info:
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Nlm Unique ID: 7506858 Medline TA: Ann N Y Acad Sci Country: United States |
Other Details:
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Languages: eng Pagination: 69-87 Citation Subset: IM |
Copyright Information:
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© 2011 New York Academy of Sciences. |
Affiliation:
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Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA. nlaiteer@medicine.bsd.uchicago.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Algorithms Cardiovascular Diseases / complications Chronic Pain / complications Comorbidity Diabetes Complications / epidemiology, therapy* Diabetes Mellitus / epidemiology, therapy* Disease Management Humans Patient-Centered Care Quality of Life |
| Grant Support | |
ID/Acronym/Agency:
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F32 DK089973-02/DK/NIDDK NIH HHS; F32DK089973/DK/NIDDK NIH HHS; K24 DK071933/DK/NIDDK NIH HHS; P30 DK092949/DK/NIDDK NIH HHS; P60 DK20595/DK/NIDDK NIH HHS; R01-DK-081796/DK/NIDDK NIH HHS |
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