Beyond Comorbidity Counts: How Do Comorbidity Type and Severity Influence Diabetes Patients’ Treatment Priorities and Self-Management?
Open accessAbstract
Background The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40% have at least three.Objective We sought to understand how the number, type, and severity of comorbidities influence diabetes patients' self-management and treatment priorities.Design Cross-sectional observation study.Patients A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey.Measurements We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF).Results 40% of respondents had at least 1 microvascular comorbidity, 79% at least 1 macrovascular comorbidity, and 61% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores.Conclusions The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients' self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.
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Most clinical practice guidelines target specific diseases, ignoring their relevance for patients with various comorbidities.
“In addition to the aforementioned issues with diagnostic error definitions, most clinical practice guidelines target specific diseases, ignoring their relevance for patients with various comorbidities [148,149,150].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [148]
The introductory passage labeled Abstract says that most diabetes disease-management programs and guidelines focus on diabetes and do not address the challenges of managing concomitant conditions. It does not establish the broader claim about most clinical practice guidelines across diseases. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInterindividual variability in baseline management, comorbidities, insulin sensitivity, and mode of insulin delivery contributes to the wide range of insulin adjustments reported.
“Likewise, interindividual variability in baseline management, comorbidities, insulin sensitivity, and mode of insulin delivery (MDI, AID, or HCL/AHCL) contribute to the wide range of adjustments reported.”
From A systematic review of glucocorticoid use in type 1 diabetes: Glycaemic effects and clinical management strategies (2026) · cites this paper as [63]
The Discussion (page unavailable) reports associations between comorbidity and diabetes prioritization or self-management ability, not insulin-dose adjustments. Searches for insulin sensitivity, delivery mode, and dose adjustments found no passage addressing the claimed explanation for the wide range of adjustments. (LLM, conf=0.78)
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References 37 · Cited by 330
Research works printed but not linked: 1
- Bandura A. Self-efficacy mechanism in physiological activation in health-promoting behavior. In: Madden J, Matthysse S, Barchas J, eds. Adaptation, Learning, and Affect. New York: Raven Press; 1991, 226-69.
- Authors
- Kerr, E. A., Heisler, M., Krein, S. L., Kabeto, M., Langa, K. M., Weir, D., & Piette, J. D.
- Affiliations
- Health Services Research & Development (US)
- University of Michigan (US)
- Corresponding author
- Kerr, Eve A.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2007-07-24
- Volume
- 22
- Issue
- 12
- Pages
- 1635-1640
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2219819
- OpenAlex
- W2068892774
- Cited by
- 330
- References
- 37
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 20 · 2023: 20 · 2022: 17 · 2021: 15 · 2020: 16 · 2019: 23 · 2018: 18 · 2017: 19 · 2016: 21 · 2015: 24 · 2014: 22 · 2013: 23 · 2012: 22
- FWCI
- 5.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Health Services Research and Development (U01 AG09740)
- University of Michigan (U01 AG09740)
- College of Pharmacy, University of Michigan
- Quality Enhancement Research Initiative
- National Institute on Aging (K08AG019180, AG09740, U01 AG 09740, U01AG009740, K08 AG 19180)
- National Institute of Diabetes and Digestive and Kidney Diseases (P60DK020572, P60 DK 20572)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes mellitus, multimorbidity, comorbidity severity, treatment prioritization, diabetes self-management, heart failure, microvascular complications, macrovascular complications, older adults, chronic disease
- MeSH terms
- Aged, Attitude to Health, Cross-Sectional Studies, Diabetes Mellitus, Female, Health Priorities, Heart Failure, Humans, Male, Middle Aged, Self Care, Severity of Illness Index, United States, Cohort Studies, Comorbidity
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