Treatment burdens of diabetic patients with multimorbidity among middle aged and older adults: A cross-sectional survey in 6 primary care facilities of three provinces of China

To measure treatment burden among middle-aged and older adults with diabetes and multimorbidity in primary care, identify latent burden subtypes, and analyze associated participant characteristics to inform targeted interventions for high-burden populations.

We conducted a cross-sectional survey between August and December 2023 across six primary care facilities in Shandong, Fujian, and Guangxi provinces, using data from the Multimorbidity Burden and Primary Health Care in China (MBPC) study. A total of 248 participants aged 45 years or older with diabetes and at least one additional chronic condition were included. Treatment burden across 14 dimensions was assessed using the Chinese version of the Patient Experience with Treatment and Self-Management (PETS 2.0) measure. We used Latent Profile Analysis (LPA) to identify burden subtypes and multinomial logistic regression to analyze associated factors.

The mean age of participants was 69.6 years, and 61.3% lived with three or more chronic conditions. The overall treatment burden was high, driven by dietary control (45.9 points), exercise or physical therapy (42.5 points), healthcare access (42.4 points), medical expenses (37.8 points), and health information access (31.5 points). LPA identified three burden subtypes: low overall burden, balanced moderate burden, and multidimensional high burden. Subtype differ in understanding medical information, coordinating care across departments, managing expenses, and managing medications. Conversely, dietary and exercise burdens were commonly exist across all groups with no significant differences. Participants in the multidimensional high burden group reported significantly higher percentages of "difficulty affording medical expenses," "difficulty understanding medication information," and "difficulty coordinating care" (all P < 0.001). Multinomial logistic regression indicated that older age was associated with a higher risk of being in the Multidimensional High Burden group (Relative Risk Ratio [RRR] = 1.098, P = 0.008), whereas higher education (RRR = 0.159, P = 0.008) and higher income (RRR = 0.231, P = 0.034) were associated with a lower risk.

Treatment burden among middle-aged and older adults with diabetes and multimorbidity exhibits a distinct stratified structure, driven primarily by systemic challenges such as information processing, care coordination, and healthcare costs. Older adults with lower education and income are most vulnerable to a multidimensional high-burden state. Findings highlight that chronic disease management in primary care should shift from routine clinical control to high-risk patients identification. Interventions should focus on information support, process simplification, and continuity of care.