As diabetes-related multimorbidity becomes increasingly prevalent, patients face growing demands associated with treatment and self-management. However, quantitative evidence on burden patterns and high-risk population characteristics in primary health care settings in China remains limited.

To assess management burden among middle-aged and older adults with diabetes and multimorbidity in primary health care settings from a patient-experience perspective, to identify latent burden subtypes, and to examine the sociodemographic characteristics associated with different burden profiles, thereby informing targeted identification of high-burden patients in primary care.

Data were drawn from the Multimorbidity Burden and Primary Health Care Research in China (MBPC) project. A cross-sectional survey was conducted between August and December 2023 in six primary health care institutions across three provinces in China (Shandong, Fujian, and Guangxi). A total of 248 patients aged ≥45 years with diabetes and at least one additional chronic condition were included. Management burden was assessed using the Chinese version of the Patient Experience with Treatment and Self-management (PETS 2.0), covering 14 dimensions. Latent profile analysis (LPA) was applied to identify burden subtypes, and multinomial Logistic regression was used to examine factors associated with different subtypes.

The mean age of participants was (69.6±10.1) years, and 61.3% (152/248) had three or more comorbid conditions. Overall management burden was substantial, with the highest scores observed in dietary management (45.9), exercise or physical therapy (42.5), access to health care services (42.4), medical and health care costs (37.8), and access to medical information (31.5). LPA identified three distinct burden subtypes: low overall burden (53, 21.37%), balanced moderate burden (170, 68.55%), and multidimensional high burden (25, 10.08%). Compared with patients in the balanced moderate-burden and low-burden groups, those in the multidimensional high-burden group were more likely to report difficulties in scheduling specialist appointments, arranging suitable appointment times, coping with long waiting times for consultations, affording medical-related expenses, and understanding medication-related information (all P<0.05). Multinomial Logistic regression showed that increasing age was associated with a higher likelihood of belonging to the high-burden group (RRR=1.098, P=0.008), whereas higher educational attainment (RRR=0.159, P=0.008) and higher income level (RRR=0.231, P=0.034) were associated with a lower likelihood.

Management burden among middle-aged and older adults with diabetes and multimorbidity exhibits a clear stratified structure and is primarily driven by system-related management demands, including information processing, care coordination, and financial management. Older adults and individuals with lower education and income are more likely to experience multidimensional high burden. Primary care management should move beyond routine disease control to prioritize the identification of high-burden patients and implement targeted interventions focusing on information support, process simplification, and continuity of care.