Prediabetes and comorbid Multiple Chronic Conditions among Adults in Texas: 2012-2013

Background: In 2013, 11% of adults in Texas reported being diagnosed with diabetes and 7% of adults reported borderline diabetes (prediabetes). Prior literature indicates that adults with diabetes also have serious co-morbid multiple chronic conditions (MCCs), that complicate their care, treatment, and outcomes.  Few studies have measured the association between prediabetes and MCCs. Due to lack of Texas specific information on this relationship, we investigated the association between prediabetes and MCCs among adults, 18 years and older in Texas.

Methods: Combined data from 2012 and 2013 Texas Behavioral Risk Factor Surveillance System were analyzed. The dependent variable MCCs (value range 0-6, categorized as none, 1, 2, ≥3 chronic conditions) was defined from the following self-reported “doctor-diagnosed” conditions: cardiovascular disease, cancer, chronic obstructive pulmonary disease, kidney disease, arthritis and current asthma. Primary independent variable was pre-diabetes status derived from self-reported, pre-diabetes and the referent group was adults without diabetes or prediabetes. The analysis adjusted for age, sex, race, education, household income and body mass index. Chi-square was used to assess the associations between pre-diabetes status and comorbid MCCs. Weighted data analysis using the SAS surveyfreq procedure was conducted to account for complex survey design. Cumulative logit regression models were built to determine the adjusted odds ratios (aOR) and 95% Confidence Intervals (CI) between prediabetes status and MCCs after adjusting for potential confounding factors.

Results:  Approximately 10% of adults with prediabetes reported ≥3 comorbid MCCs compared to only 3% of adults without diabetes or prediabetes . Increasing age, female gender, Hispanic race, less than high school education, lower household income and obesity were significantly associated with a higher prevalence of MCCs. After adjusting for potential confounders, adults with prediabetes had roughly twice the increased odds (aOR: 1.9, 95% CI: 1.5-2.4) of reporting ≥3 comorbid MCCs as compared to adults without prediabetes or diabetes.

Conclusions: Comorbid MCCs were common among adults with prediabetes in Texas. Public health and lifestyle management interventions targeted towards adults with prediabetes might help in preventing onset of diabetes and comorbid MCCs and improve disease management and outcomes.