Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Background: Diabetes mellitus often occurs with other chronic diseases; however, the combined effect of the burden of the comorbidities on the outcomes of the patient has not been fully characterized. This study explores the relationship between multimorbidity of chronic diseases and clinical outcomes in diabetic patients. Methods: A retrospective study was conducted on 159 Iraqi patients with diabetes, with a two-year follow-up period in three tertiary care hospitals, where Comorbidities were determined by ICD-10 codes. Outcomes considered were glycemic control (HbA1c), hospitalization, emergency visits, 30-day hospital readmissions, and all-cause mortality. Two types of logistic regression were performed: univariate and multivariate. Results: Mean age was 58.4±11.2 years; 54.7% were male. The most common comorbidities were hypertension (74.2%), dyslipidemia (65.4%), and obesity (44.7%) where also found in outcomes our study Patients with ≥4 comorbidities had significantly worse outcomes according to higher HbA1c (9.2±1.7% vs. 7.1±0.9%, p<0.001), more hospitalizations (2.8±1.9 vs. 0.4±0.6, p<0.001), and higher mortality (17.0% vs. 2.9%, p=0.038). In multivariate analysis, cardiovascular disease (aOR 3.18, 95% CI 1.54–6.57), chronic kidney disease (aOR 3.56, 95% CI 1.68–7.54), and having ≥4 comorbidities (aOR 5.42, 95% CI 2.18–13.48) independently predicted poor outcomes. Conclusions: Chronic disease multimorbidity is a significant predictor of poor glycemic control, greater health care use, and premature death in diabetes. Improving outcomes in this population requires using models of integrated care that address the whole spectrum of comorbidity.