title: Patient complexity and risk factor control among multimorbid patients with type 2 diabetes: results from the R2D2C2 study.
abstract: BACKGROUND
  Among patients with type 2 diabetes, it is not known whether risk factor control is better or worse for those who also have heart disease, depression, multiple other comorbidities, and associated management challenges.
  
  
  OBJECTIVE
  To examine the relationship between this complex constellation of multimorbidities, adherence to treatment and risk factor control among patients with type 2 diabetes, independent of regimen intensity.
  
  
  METHODS
  Observational cross-sectional study.
  
  
  METHODS
  A total of 1314 patients with diabetes from the Reducing Racial Disparities in Diabetes Coached Care (R2D2C2) Study.
  
  
  METHODS
  A composite cardiometabolic risk factor profile was the dependent variable. Independent variables included a composite measure of patient complexity, patient-reported adherence to treatment, history of coronary heart disease (CHD), and intensity of medication regimen.
  
  
  RESULTS
  A higher proportion of the most complex patient-reported problems with adherence compared with the least complex patients (83.5% vs. 43.3%, P<0.001). Compared with those without a history of CHD, fewer patients with CHD-reported problems with medication adherence (59.3% vs. 69.3%, P<0.01) and had better risk factor control, independent of complexity and regimen intensity. Better risk factor control was independently associated with less patient complexity (P=0.003) and to history of CHD (P=0.01).
  
  
  CONCLUSIONS
  The presence of a complex illness profile was associated with poorer control of risk factors. Those with CHD were more adherent to treatment and had better risk factor control. The occurrence of CHD may present an opportunity for physicians to emphasize risk factor management. Diabetes patients with a complex illness profile may be at highest risk for cardiovascular events and in greatest need of prevention of cardiac disease.
  
  
  BACKGROUND
  Clinicaltrial.gov identifier: NCT01123239.
authors.affiliation: Department of Medicine, Division of Cardiology, University of California, Irvine, CA, USA. smalik@uci.edu
authors.forename: Shaista
authors.initials: S
authors.lastname: Malik
authors.forename: John
authors.initials: J
authors.lastname: Billimek
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.forename: Dara H
authors.initials: DH
authors.lastname: Sorkin
authors.forename: Quyen
authors.initials: Q
authors.lastname: Ngo-Metzger
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
mesh_terms: D016009:Chi-Square Distribution; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D012307:Risk Factors