Yelena Petrosyan1, Yu Qing Bai1, Anna J Koné Pefoyo2, Andrea Gruneir3, Kednapa Thavorn4, Colleen J Maxwell5, Susan E Bronskill6, Walter P Wodchis7. 1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada. 4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. 5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Ontario, Canada. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 7. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, Toronto, Ontario, Canada. Electronic address: walter.wodchis@utoronto.ca.
Abstract
OBJECTIVES: 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. METHODS: A 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. RESULTS: Compliance 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. CONCLUSIONS: Meeting 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.
OBJECTIVES: 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. METHODS: A 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. RESULTS: Compliance 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. CONCLUSIONS: Meeting 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.
Keywords:
comorbidity type; complications liées au diabète; diabetes mellitus; diabetes monitoring testing; diabetes-related complications; diabetes-related hospitalizations; diabète; hospitalisations liées au diabète; tests de surveillance du diabète; type de comorbidité
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