Comorbid Conditions and Diabetes

Comorbid Conditions and Their Effects on Your Diabetes Care

Mature female patient in exam room with doctor
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What is Comorbidity or a Comorbid Condition?

A comorbidity is a disease or condition that coexists with a primary disease but also stands on its own as a specific disease. The comorbidities may be physical or mental conditions. For example, someone can have hypertension (high blood pressure) and not have diabetes. But on the other hand, someone with diabetes very often has hypertension as well. So, hypertension is a common comorbidity of diabetes.

Comorbidities are more common than not. About 80% of Medicare spending is for patients that have four or more chronic conditions at the same time. It is easy to see why having comorbidities adds to the cost of care. Each patient is likely seeing four specialists in addition to their primary care physician, each prescribing a variety of treatments and drugs and requiring appointments, examinations, imaging procedures and laboratory tests. Then this must all be coordinated by the primary care physician. These are very expensive patients to the system.

The term multimorbidity is also used, especially if it isn't clear as to which is the primary condition or index condition. It means that multiple chronic or acute diseases and medical conditions are present within one person, without designating one as the index condition.

Sometimes comorbidities occur because they share risk factors and may have the same cause.

For example, if you are obese you are more likely to develop diabetes as well as other health conditions. Sometimes the comorbid condition is more likely to occur as a consequence of having the primary condition, such as renal failure developing in people with diabetes.

Comorbidities in Diabetes

The most common comorbidities in children and adolescents with type 2 diabetes are hypertension, dyslipidemia, and nonalcoholic fatty liver disease.

Most adults with diabetes have at least one comorbid chronic disease and up to 40% have at least three. Up to 75% of adults with diabetes also have hypertension. Other common comorbidities of diabetes are hyperlipidemia, cardiovascular disease, kidney disease, nonalcoholic fatty liver disease, and obesity. Obstructive sleep apnea is another comorbidity, which has an impact on blood pressure control as well. The risk factors of diabetes can also raise risks of certain types of cancer.

Managing Comorbidities in Diabetes

If you have diabetes, you can reduce your risk of developing comorbidities by modifying the lifestyle factors that put you at risk. This includes controlling your body weight to prevent obesity, stopping smoking, getting enough physical activity, and controlling your blood sugar levels.

Get regular medical check-ups and complete all of the health screenings that are recommended. These can identify conditions earlier in their development and may prevent full-blown diseases. Preventative medical services are included in health plans under the Affordable Care Act.

If you have a comorbid condition, be sure that your doctors are working together, so your diabetes management is considered in the treatment of the comorbid conditions. Your primary care doctor should coordinate this care, but it is important for all of your providers to be current on your medications and treatment schedules.

Sources:

Valderas JM et al. "Defining Comorbidity: Implications for Understanding Health and Health Services." Ann Fam Med. 2009 Jul; 7(4): 357–363.

Rita Rastogi Kalyani, et. al. "Association of Diabetes, Comorbidities, and A1C With Functional Disability in Older Adults Results from the National Health and Nutrition Examination Survey (NHANES), 1999–2006." Diabetes Care May 2010 vol. 33 no. 5 1055-1060.

John D. Piette, PHD and Eve A. Kerr, MD, MPH "The Impact of Comorbid Chronic Conditions on Diabetes Care." Diabetes Care March 2006 vol. 29 no. 3 725-731.

Medha N. Munshi, MD. " Managing Common Diabetes Comorbidities: Going Beyond Standard Care." Physicians Weekly, Nov 13, 2012.

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