Diabetes Complications Among Community-Based Health Center Patients with Varying Multimorbidity Patterns

Abstract

Background: Multimorbidity with diabetes mellitus (DM and ≥ 1 chronic disease) presents challenges to maintaining adequate DM control. Objective: This study evaluates the risk of DM-related complications associated with various multimorbidity/DM patterns for patients seen in community-based health centers (CHCs). Design: Retrospective cohort study from the ADVANCE multi-state practice-based clinical data network. Participants: Study included data from 132,765 patients age ≥ 45 years with DM seen in 2493 CHCs across 26 states from 10/01/2015 to 12/31/2019. Main Measures: We assessed accrual of conditions and risk of experiencing DM complications during follow-up. Primary outcome of DM complication was categorized into acute, microvascular, microvascular (end-stage), macrovascular, or other. Key exposures included mutually exclusive multimorbidity categories: (1) DM + cardiometabolic, (2) DM + other somatic, (3) DM + mental, (4) DM + mental + somatic. Key Results: At baseline, 17.2% of patients had DM only, 55.0% had DM + cardiometabolic multimorbidity, 2.3% had DM + other somatic multimorbidity, 3.0% had DM + mental multimorbidity, and 22.5% had DM + mental + somatic multimorbidity. Most DM-only patients (76.5%) developed multimorbidity with DM by study end. Compared with DM-only, adjusted risk differences of DM complications ranged from 1.4% (acute) to 8.8% (microvascular). DM + mental + somatic multimorbidity was associated with 13.4% (95%CI 12.8–14.1%) higher adjusted risk of experiencing any DM complication. Conclusions: CHCs care for increasingly complex populations of patients with DM. Tailoring disease management strategies to address comorbid cardiovascular and/or mental health conditions may be important to prevent acute, microvascular, and macrovascular complications in these settings.