Multimorbidity, glycaemic variability and time in target range in people with type 2 diabetes: A baseline analysis of the GP-OSMOTIC trial

Multimorbidity, Frailty and Diabetes in Older People-Identifying Interrelationships and Outcomes

Multimorbidity and frailty are highly prevalent in older people with diabetes. This high prevalence is likely due to a combination of ageing and diabetes-related complications and other diabetes-associated comorbidities. Both multimorbidity and frailty are associated with a wide range of adverse outcomes in older people with diabetes, which are proportionally related to the number of morbidities and to the severity of frailty. Although, the multimorbidity pattern or cluster of morbidities that have the most adverse effect are not yet well defined, it appears that mental health disorders enhance the multimorbidity-related adverse outcomes. Therefore, comprehensive diabetes guidelines that incorporate a holistic approach that includes screening and management of mental health disorders such as depression is required. The adverse outcomes predicted by multimorbidity and frailty appear to be similar and include an increased risk of health care utilisation, disability and mortality. The differential effect of one condition on outcomes, independent of the other, still needs future exploration. In addition, prospective clinical trials are required to investigate whether interventions to reduce multimorbidity and frailty both separately and in combination would improve clinical outcomes.

Multimorbidity and catastrophic health expenditure among patients with diabetes in China: a nationwide population-based study

INTRODUCTION

Multimorbidity is common among patients with diabetes and can lead to catastrophic health expenditure (CHE) for their families. This study aims to investigate the prevalence of multimorbidity and CHE among people with diabetes in China, and the association between multimorbidity and CHE and whether this is influenced by socioeconomic status and health insurance type.

METHODS

A national survey was conducted in China in 2013 that included 8471 people aged ≥18 years who were living with diabetes. The concentration curve and concentration index were used to measure socioeconomic-related inequalities. Factors influencing CHE and the impact of multimorbidity on CHE according to socioeconomic status and health insurance type were examined by logistic regression.

RESULTS

There were 5524 (65.2%) diabetes patients with multimorbidity. The prevalence of CHE was 56.6%, with a concentration index of -0.030 (95% CI -0.035 to -0.026). For each additional chronic disease, the probability of CHE increased by 39% (OR=1.39, 95% CI 1.31 to 1.47). Factors that were positively associated (p<0.05) with CHE included older age; male sex; lower educational level; being retired, unemployed or jobless; being a non-smoker and non-drinker; having had no physical examination; lower socioeconomic status; being in an impoverished family; and residing in the central or western regions. Among participants with Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical Scheme, the probability of CHE increased by 32% (OR=1.32, 95% CI 1.23 to 1.43), 43% (OR=1.43, 95% CI 1.24 to 1.65) and 47% (OR=1.47, 95% CI 1.33 to 1.63), respectively, with each additional chronic disease. The association between multimorbidity and CHE was observed across all health insurance types irrespective of socioeconomic status.

CONCLUSIONS

Multimorbidity affects about two-thirds of Chinese patients with diabetes. Current health insurance schemes offer limited protection against CHE to patients' families.