Multimorbidity patterns among rural adults with Type-2 diabetes mellitus: A cross-sectional study in Kerala, India.

Abstract

The study evaluated the prevalence and pattern of multi-morbidity among rural adults with type-2 diabetes mellitus and explored the factors associated with multi-morbidity among 400 adult diabetic patients from rural areas of Thiruvananthapuram district in the Kerala state of India. The presence of multi-morbidity was assessed using a semi-structured interview schedule based on the physician's confirmation. The reported chronic diseases were classified as concordant (conditions with a similar pathophysiologic risk profile as diabetes) and discordant (conditions whose treatments are not directly related to the pathogenesis for diabetes) co-morbidity. Multivariate analysis was done to find the factors associated with multi-morbidity. Prevalence of multi-morbidity among diabetic patients was 74% (95% Confidence Interval (CI): 69-77), around 66% reported at least one concordant co-morbidity, 30% reported at least one discordant co-morbidity and 21% reported both concordant and discordant co-morbidity with diabetes. Hypertension (59%) was the most frequent co-morbidity. Older adults (above 60 years of age) [Odds Ratio (OR):3.42, 95% CI:1.97-5.94] and women (OR:2.16, CI:1.13-3.51) were more likely to have multi-morbidity compared to their counterparts. Those using insulin and/or oral medication were more likely to have multi-morbidity compared to those using oral medication only (OR: 2.19, CI: 1.07-4.09). Multi-morbidity among diabetic patients needs to be addressed by a comprehensive and integrated approach rather than a diabetes specific approach.