Polymorbidity in diabetes in older people: consequences for care and vocational training.

Objective: To investigate the prevalence of complicating and concurrent morbidities in older diabetic patients and to evaluate to what extent their occurrence affects the burden of disease and use of medical healthcare.

Study Design: Cross-sectional analysis of retrospectively obtained data on comorbidities and use of medical healthcare. Healthcare registration systems were used to retrieve data on 300 patients with diabetes aged >or=60 years who, according to the severity of their disease and intensity of care required, were treated in a regional general practitioner (GP), diabetes nurse specialist (DNS) or medical specialist (MS) practice.

Results: Complicating and concurrent morbidities were often found irrespective of the type of practice involved. After adjustments for differences in sex, age and glycosylated haemoglobin (HbA1c), the extent of complicating comorbidities showed sequential increases in patients managed by GP, DNS and MS (mean number of 3.6, 4.7 and 6.7, respectively; p(trend)<0.001). However, the mean number of concurrent comorbidities was similar across all three settings (2.1, 1.8 and 2.0, respectively). Both complicating and concurrent comorbidities were similarly associated with the extent of drug use (beta = 0.49 (95% CI 0.40 to 0.58) and beta = 0.57 (95% CI 0.52 to 0.72), respectively) and the number of consultations with specialists other than the main care giver (beta = 1.19 (95% CI 1.15 to 1.24) and beta = 1.21 (95% CI 1.14 to 1.28), respectively). However, the mean number of different specialists involved in a patient's care per additional concurrent comorbidity was twice as high as per any additional complicating comorbidity (beta = 0.60 (95% CI 0.48 to 0.71) vs beta = 0.31 (95% CI 0.24 to 0.39)).

Conclusions: The use of healthcare facilities by older patients with diabetes is substantial, irrespective of the complexity of the disease and the kind of practice involved. The common manifestation of complicating and concurrent comorbidities and their varying complexity in individual patients requires a patient-oriented rather than a disease-oriented approach and vocational training programmes for care givers that are tailored to the complexity of multiple chronic diseases.