Treatment Burden And Influencing Factors Among Middle-Aged And Elderly Community-Dwelling Patients With Diabetes And Multimorbidity

Objective:1.To describe the current treatment burden of type 2 diabetes comorbidities in the community.2.To explore the factors affecting the treatment burden of community diabetic patients.3.To provide a reference for healthcare providers to take targeted intervention measures to reduce the treatment burden of middle-aged and elderly patients with diabetes comorbid patients.Methods:Cross-sectional study was used.A total of 593 middle-aged and elderly patients with type 2 diabetes were selected from three community health service centers in Hongkou District,Shanghai from August 2021 to December 2021 through convenience sampling.A questionnaire was used to fill in the basic data,multimorbidity treatment burden questionnaire,Charlson Comorbidity Index evaluation form,Bayliss disease burden impact scale,Euro Qol five-dimensional questionnaire,patient assessment of chronic illness care,diabetes self-management questionnaire,diabetes distress scale,health literacy management scale.The treatment burden of multimorbid patients with type 2 diabetes was investigated,and the influencing factors of social demographic characteristics,health literacy,quality of life,disease burden,disease self-management ability,diabetes distress,and other factors on the treatment burden of multimorbid patients with type 2 diabetes were explored.SPSS 26.0software was used for data collation and analysis.Results:1.The total score of the multimorbidity treatment burden questionnaire was4.17(0.00,10.94),and the score of each dimension was 0(0,3)for medication and expenditure,0(0,2)for medical treatment,and 1(0,2)for lifestyle.The highest average scores for the three-dimensional items were the lifestyle dimension.Among them,61.9 percent had the burden of treatment.2.The results of multiple linear regression analysis show that: The influencing factors of the treatment burden included the score of diabetes distress,health utility value,difficulty in paying bills in the past year,Charlson comorbidity index,the score of the patient assessment of chronic illness care,educational level,hypoglycemia,Bayliss disease burden,and residence status.These nine factors could explain 54.1% of the total variation.Patients with higher disease distress scores had a higher treatment burden;patients with higher health utility value had a lower treatment burden;patients who had difficulty paying bills in the past year had a higher treatment burden;patients with a higher quality of patient assessment of chronic illness care had a lower treatment burden;patients with higher educational level had a lower treatment burden;patients with higher Charlson Comorbidity Index scores had a higher treatment burden;patients with higher Bayliss Disease Burden scores had a higher treatment burden;patients who had experienced hypoglycemia had a higher treatment burden;and patients who lived with their spouses had a lower treatment burden.Multiple linear regression analysis of the dimensions of treatment burden showed that,in addition to the above factors,the burden of the lifestyle dimension was higher in patients with higher age;the burden of the consultation dimension was higher in patients with poorer economic status;the burden of the consultation dimension and the lifestyle dimension was higher in patients with longer duration of diabetes;and the burden of the lifestyle dimension was lower in patients with regular exercise.Conclusion:The treatment burden for middle-aged and elderly patients with type 2 diabetes in the community is less than ideal,with the highest lifestyle burden.The influencing factors of the treatment burden included the score of diabetes distress,health utility value,difficulty in paying bills in the past year,Charlson comorbidity index,the score of the patient assessment of chronic illness care,educational level,hypoglycemia,Bayliss disease burden,residence status,age,economic status,duration of diabetes,and whether regular exercise.Healthcare providers should raise awareness of the assessment and intervention of treatment burden in multimorbid patients with type 2 diabetes,implement effective patient-centered and targeted interventions,and provide individualized care and educational guidance to reduce their treatment burden and ultimately improve their health status.