The Relationship between Diabetes Care Quality and Diabetes-Related Hospitalizations and the Modifying Role of Comorbidity

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• 作者：Yelena Petrosyan ; MD^a ; Yu Qing Bai ; MSc^a ; Anna J. Koné ; Pefoyo ; PhD^a ; ^b ; Andrea Gruneir ; PhD^a ; ^c ; ^d ; ^e ; Kednapa Thavorn ; PhD^c ; ^f ; ^g ; Colleen J. Maxwell ; PhD^c ; ^h ; Susan E. Bronskill ; PhD^a ; ^c ; Walter P. Wodchis ; PhD^a ; ^c ; ⁱ ; ^{walter.wodchis@utoronto.ca}
• 关键词：diabetes mellitus ; comorbidity type ; diabetes monitoring testing ; diabetes-related hospitalizations ; diabetes-related complications
• 刊名：Canadian Journal of Diabetes
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：41
• 期：1
• 页码：17-25
• 全文大小：308 K
• 卷排序：41

文摘

To evaluate the impact of comorbidity on diabetes care quality and diabetes-related hospitalizations and to examine whether associations between the likelihood of diabetes-related hospitalizations and compliance with diabetes testing are modified by type of comorbidity.MethodsA population-based cohort study of 861 354 adults with diabetes was conducted in Ontario, Canada. The diabetes cohort was categorized into 4 groups defined by their comorbidity statuses: no comorbidity, diabetes-concordant only, diabetes-discordant only, and both concordant and discordant. Outcome variables were defined as having had at least 1 hospitalization for diabetes-related short- or long-term complications between 2009 and 2011. Diabetes-care quality measures included testing for glycated hemoglobin (A1C) and low-density lipoprotein-cholesterol levels and eye examinations between 2007 and 2009. Multivariable logistic regression models were performed to examine the associations between diabetes testing and diabetes-related hospitalizations and the modifying role of comorbidity type.ResultsCompliance with all 3 monitoring tests by patients with diabetes had a strong positive impact on reducing hospitalizations for diabetes-related long-term complications, especially in patients with diabetes-concordant conditions. The highest levels of adherence to all 3 diabetes monitoring tests were observed in patients with diabetes-concordant conditions only and in patients with diabetes-discordant conditions. The highest odds of hospitalizations for diabetes-related short-term complications were observed in patients having both discordant and concordant conditions.ConclusionsMeeting diabetes testing goals has the potential to reduce hospitalizations for diabetes-related complications; however, this depends on types of coexisting chronic conditions and diabetes-related complications in patients with diabetes.