Journal of General Internal Medicine

, Volume 22, Issue 12, pp 1635–1640 | Cite as

Beyond Comorbidity Counts: How Do Comorbidity Type and Severity Influence Diabetes Patients’ Treatment Priorities and Self-Management?

  • Eve A. KerrEmail author
  • Michele Heisler
  • Sarah L. Krein
  • Mohammed Kabeto
  • Kenneth M. Langa
  • David Weir
  • John D. Piette
Original Article



The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40% have at least three.


We sought to understand how the number, type, and severity of comorbidities influence diabetes patients’ self-management and treatment priorities.


Cross-sectional observation study.


A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey.


We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF).


40% of respondents had at least 1 microvascular comorbidity, 79% at least 1 macrovascular comorbidity, and 61% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores.


The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients’ self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.


comorbidity discordant conditions diabetes mellitus self-management 



The authors thank Myra Kim, PhD, for statistical advice and Emily Clark for manuscript preparation. Dr. Piette is a VA Career Scientist. Dr. Heisler is a VA Career Development Awardee. Dr. Langa is an NIA Career Development and Paul Beeson Physician Faculty Scholar Awardee. This work was supported by the National Institute on Aging (U01 AG09740 and K08 AG19180); the Michigan Diabetes Research and Training Center from the NIDDK (P60DK-20572); and the Department of Veteran’s Affairs (VA) Health Services Research and Development Quality Enhancement Research Initiative for Diabetes Mellitus (QUERI-DM; DIB 98-001).

Statement on Financial Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Eve A. Kerr
    • 1
    • 2
    Email author
  • Michele Heisler
    • 1
    • 2
  • Sarah L. Krein
    • 1
    • 2
  • Mohammed Kabeto
    • 2
  • Kenneth M. Langa
    • 1
    • 2
    • 3
  • David Weir
    • 3
  • John D. Piette
    • 1
    • 2
  1. 1.VA HSR&D Center of ExcellenceVA Ann Arbor Health Care SystemAnn ArborUSA
  2. 2.Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  3. 3.University of Michigan Institute for Social ResearchAnn ArborUSA

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