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BACKGROUND: In 2013, 11% of adults in Texas reported being diagnosed with diabetes and an additional 7% of adults self-reported borderline diabetes (prediabetes). Prior literature has shown that adults with diabetes also have serious co-morbid multiple chronic conditions (MCC), that complicate their care, treatment, and outcomes. Due to a lack of a Texas specific investigation, we determined the association between diabetes status and MCC among adults, 18 years and older in Texas.
METHODS: Combined data from Texas Behavioral Risk Factor Surveillance System for 2012 and 2013 were analyzed. The dependent variable MCC (value range 0-6, categorized as none, 1, 2, ≥3 chronic conditions) was defined from the following self-reported “doctor-diagnosed” conditions: cardiovascular disease, cancer, chronic obstructive pulmonary disease, kidney disease, arthritis and current asthma. Primary independent variable was diabetes status derived from self-reported, doctor-diagnosed diabetes, pre-diabetes and none. The analysis adjusted for age, sex, race, education, household income and body mass index. Chi square tests were used to determine the associations between diabetes status and presence of comorbid MCC and potential confounders. Weighted cumulative logit regression model was built to account for complex survey design and determine the adjusted odds ratios (aOR) and 95% Confidence Intervals (CI) between diabetes status and MCC after adjusting for potential confounding factors.
RESULTS: Approximately 13% of adults in Texas had ≥2 MCC. Approximately 14% adults with diabetes reported ≥3 comorbid MCC and approximately 10% of adults with prediabetes reported ≥3 comorbid MCC compared to 3% of adults with MCC among adults without diabetes or prediabetes . Increasing age, female gender, Hispanic race, less than high school education, lower household income and obesity were significantly associated with a higher number of MCC. After adjusting for potential confounders, adults with diabetes had roughly 2.4 times increased odds (aOR: 2.0, 95% CI: 2.0-2.9) of reporting ≥3 comorbid MCC and adults with prediabetes had roughly twice the odds (aOR: 1.9, 95% CI: 1.5-2.4) of reporting ≥3 comorbid MCC as compared to adults without prediabetes or diabetes.
CONCLUSIONS: Comorbid MCC was common among adults with diabetes and prediabetes in Texas. Public health and lifestyle management interventions targeted towards adults with diabetes and borderline diabetes might help in preventing onset of comorbid MCC and improve diabetes management and outcomes.