Comorbidity and glycemic control in patients with type 2 diabetes.
BACKGROUND
It is commonly believed that good glycemic control is hard to achieve in patients with diabetes mellitus and concurrent chronic illnesses.


OBJECTIVE
To determine the impact of comorbidity on glycemic control at presentation and subsequent follow-up in patients with type 2 diabetes.


METHODS
We studied 654 consecutive patients who presented to a diabetes clinic in 1997. Comorbidity was rated using the Chronic Disease Score (CDS) index, which is a validated, weighted score that takes into account the patient's age, sex, and classes of medications. Univariate and multivariate linear regressions were used to determine the contribution of age, body mass index (calculated as weight in kilograms divided by the square of height in meters), diabetes duration, type of therapy, and CDS to initial hemoglobin A(1c) (HbA(1c)) level. A similar analysis was performed for the 169 patients with follow-up HbA(1c) levels 6 months after presentation.


RESULTS
Patients were 90% African American, and 66% female, with average age of 53 years. Average diabetes duration was 5 years; body mass index, 33; HbA(1c) level, 8.8%; and CDS, 1121 (range, 232-7953). At presentation, patients with higher CDSs tended to be older and to have a lower HbA(1c) level, but multivariate linear regression showed that receiving pharmacological therapy, younger age, and having a lower C-peptide level were the only significant contributors to HbA(1c) level. In the 169 follow-up patients, presenting characteristics were not significantly different from those of the full cohort: average initial HbA(1c) level was 8.8%; CDS, 1073. Their HbA(1c) level at 6 months averaged 7.5% and the CDS had no significant impact on their follow-up HbA(1c) level.


CONCLUSIONS
Comorbidity does not appear to limit achievement of good glycemic control in patients with type 2 diabetes.
El-Kebbi
I M
IM
Department of Medicine, Emory University School of Medicine, Diabetes Unit, 69 Butler St SE, Atlanta, GA 30303, USA. ielkebb@emory.edu
Ziemer
D C
DC
Cook
C B
CB
Miller
C D
CD
Gallina
D L
DL
Phillips
L S
LS
D017677:Age Distribution; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007239:Infections / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D018709:Statistics, Nonparametric
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents