Background

Among patients with type 2 diabetes, it is not known whether risk factor control is better or worse for those who also have heart disease, depression, multiple other co-morbidities and associated management challenges.

Objective

To examine the relationship between this complex constellation of multi-morbidities, adherence to treatment and risk factor control among patients with type 2 diabetes, independent of regimen intensity.

Research Design

Observational cross-sectional study.

Subjects

1314 patients with diabetes from the Reducing Racial Disparities in Diabetes Coached Care (R2D2C2) Study.

Measures

A composite cardiometabolic risk factor profile (CMRP) was the dependent variable. Independent variables included a composite measure of patient complexity, patient-reported adherence to treatment, history of coronary heart disease (CHD), and intensity of medication regimen.

Results

A higher proportion of the most complex patients reported problems with adherence compared to the least complex patients (83.5% vs. 43.3%, p<.001). Compared to those without a history of CHD, fewer patients with CHD reported problems with medication adherence (59.3% vs. 69.3%, p<.01) and had better risk factor control, independent of complexity and regimen intensity. Better risk factor control was independently associated with less patient complexity (p=.003) and to history of CHD (p=.01).

Conclusions

The presence of a complex illness profile was associated with poorer control of risk factors. Those with CHD were more adherent to treatment and had better risk factor control. The occurrence of CHD may present an opportunity for physicians to emphasize risk factor management. Absent such a dramatic event, diabetes patients with a complex illness profile may be at highest risk for cardiovascular events and in greatest need of prevention of cardiac disease.