1070 — The Effect of Comorbidity on Glycemic Control in Diabetics
Vaughan Sarrazin MS (Iowa City VA Health System) , Barnett M
(Iowa City VA Health System), Rosenthal GE
(Iowa City VA Health System)
Evaluate the impact of comorbidity on glucose control in diabetic patients.
Pharmacy and laboratory data from the Decision Support System for FY 2004 for VISNs 10, 15, and 23 were used to identify 69,121 patients (mean age 66.5 years, 2.1% female) who received prescriptions for oral hypoglycemics or insulin and a glycosylated hemoglobin (AIC) value (for patients with more than one AIC, the first value was used). The presence of 30 comorbid conditions was identified from ICD-9-CM codes for all outpatient encounters during the 12 months prior to the first prescription date, using algorithms developed by Elixhauser. The relationship between the number of comorbid conditions and the likelihood of A1C values > 7.0 or > 9.0 was evaluated using multiple logistic regression, controlling for age, sex, income, and service connected disabilities.
The mean A1C value was 7.4 (SD=1.5), with 51% of patients having A1C >7.0 and 26% having A1C>9.0. The proportion of patients with 1 comorbid condition (in addition to diabetes) was 27%, while 25%, 16%, 8%, and 7% had 2, 3, 4, and 5 or more conditions. Compared to patients with no additional comorbid conditions, the adjusted odds of having an A1C >7.0 were 1.12 (95% CI, 1.07-1.17), 1.16 (95% CI, 1.11-1.22), and 1.24 (95% CI, 1.15-1.33) for patients with 1 to 2, 3 to 4, and 5 or more conditions, respectively. The odds of having an A1C > 9.0 were 1.13 (95% CI, 1.05-1.21), 1.25 (95% CI, 1.16-1.35), and 1.35 (95% CI, 1.22-1.50) for patients with 1 to 2, 3 to 4, and 5 or more comorbid conditions, respectively.
The presence of greater numbers of comorbid illnesses is associated with higher A1C values in veterans with diabetes.
Maintenance of glucose control is more difficult for diabetics with greater numbers of comorbid conditions. Management strategies for glucose control should account for such factors. Moreover, performance measures and benchmarks for evaluating care of patients with diabetes need to consider patient complexity and adjust for the number of other comorbidities.