Diabetes Multimorbidity Typology, Trajectory, and Feasibility of an Audio Diary Mobile Application to Support Self-management

Multimorbidity, defined as the presence of two or more chronic health conditions, is increasingly common among adults aging with long-term illnesses. Diabetes is one of the most prevalent chronic conditions contributing to multimorbidity and is associated with a wide range of complications, including cardiovascular disease, kidney disease, neuropathy, mental health symptoms, and functional decline. Many individuals with diabetes also live with additional chronic conditions such as hypertension, arthritis, or mood disorders, which together create complex care needs and daily symptom challenges. Although multimorbidity is known to increase healthcare utilization, costs, and burden on individuals and caregivers, the specific patterns, trajectories, and risk factors associated with diabetes-related multimorbidity remain insufficiently understood. Existing research has described multimorbidity using cross-sectional clustering, network analysis, and other data-driven methods. More recent studies have used longitudinal modeling, disease-transition analyses, and machine-learning approaches to examine how chronic conditions develop and progress over time. However, these studies have largely relied on secondary data sources such as electronic health records or insurance claims. As a result, they provide limited insight into the lived experience of individuals managing multiple chronic conditions, the daily symptoms they encounter, and the strategies they use to regulate their health and functioning. There is also limited evidence on how multimorbidity typologies and trajectories specifically manifest in people with diabetes, or how social, behavioral, and contextual factors influence these patterns. Self-management plays a central role in diabetes care, yet many individuals with diabetes and multimorbidity report feeling insufficiently involved in clinical decision-making or goal setting. Daily self-regulation strategies-such as prioritizing tasks, optimizing available resources, and compensating for limitations-may help individuals manage symptoms and maintain quality of life. These strategies can be influenced by pain, fatigue, sleep disturbance, mood symptoms, cognitive changes, and communication with healthcare providers. Understanding how individuals use these strategies in real-world settings may help identify opportunities to support more effective and personalized self-management. Audio diaries offer a promising method for capturing real-time experiences, reflections, and self-management behaviors. Compared with written diaries, audio diaries may be easier for older adults to use and can capture additional information such as tone, pauses, and emotional expression. Early work with audio-based tools suggests they may support self-reflection and provide insight into physical, emotional, and social well-being. However, the feasibility, usability, and acceptability of audio diaries among older adults with diabetes and multimorbidity have not been fully evaluated. This study aims to address these gaps by examining diabetes-related multimorbidity typologies, trajectories, and associated risks using advanced analytic methods, and by exploring daily self-management through an adapted audio diary mobile application. Guided by a self-regulation framework, the study will assess the feasibility of using an audio diary tool to document daily experiences, symptom patterns, and self-regulation strategies among adults living with diabetes and multiple chronic conditions. The study will also explore how audio diary data may inform future interventions designed to support self-management and improve quality of life. The findings from this study are expected to contribute to a better understanding of how multimorbidity develops and progresses in individuals with diabetes, how daily symptoms and self-management strategies interact, and how audio-based tools may be used to support ongoing care. This work will lay the foundation for future longitudinal and intervention studies aimed at improving health outcomes for individuals aging with multiple chronic conditions.