title: Comorbidity in patients with diabetes mellitus: impact on medical health care utilization.
abstract: BACKGROUND
  Comorbidity has been shown to intensify health care utilization and to increase medical care costs for patients with diabetes. However, most studies have been focused on one health care service, mainly hospital care, or limited their analyses to one additional comorbid disease, or the data were based on self-reported questionnaires instead of health care registration data. The purpose of this study is to estimate the effects a broad spectrum of of comorbidities on the type and volume of medical health care utilization of patients with diabetes.
  
  
  METHODS
  By linking general practice and hospital based registrations in the Netherlands, data on comorbidity and health care utilization of patients with diabetes (n = 7,499) were obtained. Comorbidity was defined as diabetes-related comorbiiabetes-related comorbidity. Multilevel regression analyses were applied to estimate the effects of comorbidity on health care utilization.
  
  
  RESULTS
  Our results show that both diabetes-related and non diabetes-related comorbidity increase the use of medical care substantially in patients with diabetes. Having both diabeterelated and non diabetes-related comorbidity incrases the demand for health care even more. Differences in health care utilization patterns were observed between the comorbidities.
  
  
  CONCLUSIONS
  Non diabetes-related comorbidity increases the health care demand as much as diabetes-related comorbidity. Current single-disease approach of integrated diabetes care should be extended with additional care modules, which must be generic and include multiple diseases in order to meet the complex health care demands of patients with diabetes in the future.
authors.affiliation: Department for Prevention and Health Services Research, National Institute of Public Health and the Environment, A,van Leeuwenhoekstraat 9, 3720 BA Bilthoven, The Netherlands. jeroen.struijs@rivm.nl
authors.forename: Jeroen N
authors.initials: JN
authors.lastname: Struijs
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.forename: Francois G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
authors.forename: Geertrudis A M
authors.initials: GA
authors.lastname: van den Bos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology* / Q000628:therapy; D017719:Diabetic Foot / Q000453:epidemiology / Q000628:therapy; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014600:Utilization Review