Taking Control When Multiple Conditions Occur

Diabetes blood pressure and cholesterol can be challenging to control at the same time

(RxWiki News) For more than 75 million people living with multiple, chronic medical conditions, taking care of their health is a daily challenge. Managing multiple conditions at the same time can seem overwhelming, but with the right guidance from a doctor, it can be done.

A recent study assessed the ability to control diabetes, blood pressure and cholesterol levels in patients in Colorado.

The study found that control of all conditions at the same time was uncommon and usually temporary. The patients who were able to control multiple conditions simultaneously were most often those who were actively involved in their treatment, by regularly taking their medication and keeping up with their doctor’s appointments.

"Talk to your doctor about your current treatment plan."

Emily B. Schroeder, MD, PhD, of the Institute for Health Research, Kaiser Permanente Colorado, and team studied used the hypertension registry of Denver Health (DH) and the diabetes mellitus registry of Kaiser Permanente Colorado (KPCO) to study patients with diabetes, hypertension and hyperlipidemia between 2000 and 2008.

DH is an inner-city integrated healthcare delivery system in Denver, Colorado and KPCO is a large managed care group with well developed disease management programs.

The DH group consisted of 5,369 individuals with an average age of 56.4 years old and a follow-up time of four years. Thirty-nine percent were male and 81.5 percent were racial minorities, with 28.7 percent reporting Spanish as their primary language.

The KPCO group consisted of 23,458 individuals with an average age of 62 years old and had a median follow-up time of 4.4 years. About 52 percent were male and 31.4 percent were racial minorities, with only two percent requesting language interpreters.

Examination of blood pressure and laboratory measurements showed that only 16 percent of individuals in the DH group and 30 percent from KPCO were able to achieve simultaneous control of all three conditions at some point.

When the definition of simultaneous control was relaxed to include those with slightly higher blood pressure and cholesterol, 44 percent of the DH group and 70 percent of the KPCO group achieved the goal.

Unfortunately, this control was transient. Only 13 percent of the DH group and five percent of the KPCO group maintained control until the end of the observation period.

In both groups, loss of simultaneous control was most commonly due to elevated blood pressure, followed by cholesterol.

Age, ethnicity and the presence of cardiovascular disease or other conditions had an effect on the individuals likelihood to control all three conditions but did not necessarily predict control.

However, medication adherence was a major predictor of simultaneous control.

Those who were able to simultaneously control all conditions could offer valuable insight as to what was effective self-care for individuals with multiple health conditions.

"Although the reasons for poor control of risk factors were not entirely clear, it was not surprising that those people who took their medications regularly and saw their primary physicians more frequently were somewhat more likely to effectively manage their health problems," says Sarah Samaan, MD, FACC, author of Best Practices for a Healthy Heart: How to Stop Heart Disease Before or After it Starts.

"When patients understand the consequences of their lifestyle choices, then they are more apt to take their health seriously," she adds. "It is important that primary care physicians and specialists such as cardiologists and endocrinologists make clear to our patients that we are not merely chasing 'numbers', but that these numbers actually translate into better health outcomes, lower overall cost of care, and improved quality of life."

Limitations to this study include the possibility for separate inclusion criteria between DH and KPCO databases, a lack of awareness of patient conditions prior to treatment, differences in data taking methods during routine doctor’s visits and any variables resulting from services the patients received outside of DH and KPCO.

The study will be published in the upcoming September issue of the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes and was funded by the National Heart, Lung and Blood Institute Cooperative, a grant from the Agency for Healthcare Research and Quality and the Colorado Clinical Translational Sciences Institute.

Dr. Schroeder was supported by the National Institute of Diabetes and Digestive and Kidney Diseases Training grant and a grant from the Endocrine Fellows Foundation.

The research team reports no conflicts of interest.

Review Date: 
August 6, 2012