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Diabetes comorbidities



New study: Many diabetes patients with multiple comorbidities

don’t get the best possible care


BOSTON (Mar. 9) – Many diabetes patients with multiple chronic comorbidities (MCCs) have poor diabetes outcomes and excess emergency department visits and 30-day hospital readmissions, adding $15 billion nationally in potentially unnecessary health care costs, a new study from Tufts Medical Center has found.

MCCs are highly prevalent in diabetes patients. Having MCCs can complicate treatment and increase disease burden and health care costs.  The findings of this study indicate that diabetes guidelines and disease management programs should explicitly address common comorbidity clusters, such as hypertension-hyperlipidemia-obesity, commonly referred to as “metabolic syndrome.”  Patients with MCCs would likely benefit from coordinating the care of these clusters rather than having each disease treated on its own.

The research, funded by the West Health Institute and employing big data analysis, looked at patients who have significant chronic illness in addition to their diabetes, and studied whether they are getting the coordinated care they need to achieve better health. It found that diabetes patients with certain comorbidity profiles, such as those with obesity only, were less likely to have recommended, diabetes-related face-to-face visits with clinicians and less likely to meet treatment goals for long-term blood sugar management, while they were more likely to have emergency department visits and readmissions.

The study also reported that reducing emergency department visits and 30-day readmissions in patients with diabetes could yield substantial savings nationally- roughly $15 billion annually.

“This study is the first that we are aware of to examine a large number of the most common MCC combinations in diabetes,” said lead author Pei-Jung Lin, Ph.D., an Assistant Professor at Tufts Medical Center.

“Although previous studies have shown that the type and severity of comorbidities, not just the number of conditions, matter, we believe we are the first to investigate which MCC clusters are most prevalent in diabetes and how MCCs impact patient outcomes,” she said. Explicit consideration of MCC clusters is important because appropriate management of individual diseases in isolation may not be optimal for patients with MCCs.

The analysis was based on more than 160,000 type 2 diabetes patients in Optum’s Humedica datasets, which link de-identified electronic health records, encounter files, prescribed medications, and lab values supplied by many large U.S. providers.

“Analyzing distinct MCC combinations as we have done is only possible using big data,” Lin said.

 Lin P-J, Kent DM, Winn A, Cohen JT, Neumann PJ. Multiple Chronic Conditions in Type 2 Diabetes Mellitus: Prevalence and Consequences. AJMC 2015 February 27. [Epub ahead of print].


About the Center for the Evaluation of Value and Risk in Health (CEVR)

 Since its inception in 2006, the Center for the Evaluation of Value and Risk in Health (CEVR) at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston has been a leader on issues pertaining to value, cost-effectiveness, and risk tradeoffs in health care decisions.  Our mission is to analyze the benefits, costs, and risks of strategies to improve health and health care and to communicate the findings to clinicians and policymakers.


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