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Comorbidities and Diabetes Care – Impact on Treatment Strategies

Comorbidities and Diabetes Care – Impact on Treatment Strategies. Dr. Joel Rodriguez-Saldana Multidisciplinary Diabetes Centres Mexico . Prevalence and Multimorbidity Patterns in Australia. Britt HC et al: MJA 2008;189:72-77. Prevalence of Multimorbidity by Gender and Age Group.

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Comorbidities and Diabetes Care – Impact on Treatment Strategies

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  1. Comorbidities and Diabetes Care – Impact on Treatment Strategies Dr. Joel Rodriguez-Saldana Multidisciplinary Diabetes Centres Mexico

  2. Prevalence and MultimorbidityPatterns in Australia Britt HC et al: MJA 2008;189:72-77

  3. Prevalence of MultimorbiditybyGender and AgeGroup Britt HC et al: MJA 2008;189:72-77

  4. Epidemiology of Multimorbidity and Implications • Background: healthsystems are configuredfor individual diseases, ratherthanmultimorbidity • Objective: to examine thedistribution of multimorbidity and of comorbidity of physical and mental healthdisorders, in relationtoage and soocioeconomicdeprivation Barnett K et al: Lancet 2012;380:37-43

  5. Epidemiology of Multimorbidity and Implications • Methods: a crosssectionalstudyon 40 morbiditiesfrom a database of 1,751,841 peopleregisteredwith 314 medicalpractices in Scotland. • Multimorbiditywasdefined as thepresence of twoor more disorders Barnett K et al: Lancet 2012;380:37-43

  6. Number of ChronicDisordersbyAgeGroup Barnett K et al: Lancet 2012;380:37-43

  7. Epidemiology of Multimorbidity and Implications • Results: 42.2% (CI 42.1-42.3) of allpatientshadoneor more morbidities, and 23.2% weremultimorbid • Multimorbidityocurred 10-15 yearsearlier in people living in themostdeprivedareascomparedwiththemostaffluent Barnett K et al: Lancet 2012;380:37-43

  8. Epidemiology of Multimorbidity and Implications • Results: socioeconomicdeprivationwasparticularlyassociatedwithmultimorbiditythatincluded mental healthdisorders • Thepresence of a mental healthdisorderincreased as thenumber of physicalmorbiditiesincreased, and wasgreater in themostdeprived Barnett K et al: Lancet 2012;380:37-43

  9. Epidemiology of Multimorbidity and Implications • Conclusions: the single-diseaseframeworkbywhichmosthealthcare, medicalresearch, and medicaleducationisconfiguredmustbechallenged • A complementarystrategyisneededtoprovidepersonalised, comprehensivecontinuity of care, especially in socioeconomicallydeprivedareas Barnett K et al: Lancet 2012;380:37-43

  10. Comorbidity in Males ≥ 65 Years Steinman MA et al: JAGS 2012;60:1872-1880 N= 1,963,810

  11. Comorbidity in Females ≥ Years Steinman MA et al: JAGS 2012;60:1872-1880 N= 1,963,810

  12. MultimorbidityMMD and itsConsequences in PrimaryCare • Objective: examine theprevalence, healthcareutilization and cost of multimorbidity • Methods: 3,309 patients >50 yearsreceivingprimarycare in Ireland • Results: MMD prevalencewas 66.2% • RR associatedwith>4 vs 0: diseases • Medicalvisits: 11.9 vs 3.7, P <0.001 • Hospital admissions: 4.51, P <0.01 • Costs: EU 4, 096.86 vs EU 760.20, P <0.001 Glynn LG et al: FamPract 2011;28:516-523

  13. Number of ChronicDiseases and Prevalence of MMD Glynn LG et al: FamPract 2011;28:516-523

  14. Odds Ratio: PrimaryCareVisits, Hospital Visits and Admissions, and Number of ChronicDiseases Glynn LG et al: FamPract 2011;28:516-523

  15. Costs per PatientReceiving PC, Hospital Visits, Hospital Treatment and Total Care in USD Glynn LG et al: FamPract 2011;28:516-523

  16. Multimorbidity in PatientswithType 2 Diabetes • Objective: to examine thenature of multimorbidity, and itsimpacton GP visits, polypharmacy and glycemic control • Methods: a cohort of 424 patientswithtype 2 diabetes enrolled in a RCT in Irish general practice Teljeur C, et al: Eur J Gen Pract 2013;19:17-22

  17. Multimorbidity in PatientswithType 2 Diabetes • Results: 90% of thepatientshad at leastoneadditionalchroniccondition, and 25% had ≥4 additionalchronicconditions: • Hypertension: 66% • Heartdisease: 25% • Arthritis: 16% • GP visits and polypharmacyincreasedwithincreasednumber of chronicconditions Teljeur C, et al: Eur J Gen Pract 2013;19:17-22

  18. Multimorbidity in PatientswithType 2 Diabetes • Results: patientswhoreported a higherproportion of theirconditionshadbetterglycemic control withlower HbA1c scores • Conclusions: theprevalence of mulltimorbidity in patientswithType 2 diabetes isveryhigh. Glycemic control isrelatedtopatients’ awareness of theirchronicconditions Teljeur C, et al: Eur J Gen Pract 2013;19:17-22

  19. Comorbidity: Lines of Action • Acknowledgeitslikelihood: thesimultaneouspresence of comorbidity and multimorbidityisthenorm of populations • Peopleshouldbecharacterizedbytheirmorbidityburden and bythepatterns of morbiditythattheyexperiencewith time • Clinicaltrialsshouldcharacterizeparticipantsaccordingtomorbidityburden Starfield B: Ann FamMed 2006;4:101-103

  20. Comorbidity: Lines of Action 4. Primarycarepractitioners and researchersshouldparticipate in thedesign of studiesto test aboutcomorbidity 5. Academicdepartmentsshouldbedevelopingguidelinesforspecialtycare of comorbidity Starfield B: Ann FamMed 2006;4:101-103

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