Journal of General Internal Medicine

, Volume 27, Issue 12, pp 1674–1681

Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study

Authors

    • San Francisco VA Medical Center
    • Division of GeriatricsUniversity of California, San Francisco
  • Andrew J. Karter
    • Division of ResearchKaiser Permanente
  • Elbert S. Huang
    • Section of General Internal Medicine, Department of MedicineUniversity of Chicago
  • Howard H. Moffet
    • Division of ResearchKaiser Permanente
  • Neda Laiteerapong
    • Section of General Internal Medicine, Department of MedicineUniversity of Chicago
  • Yael Schenker
    • Division of General Internal MedicineThe University of Pittsburgh
  • Alyce Adams
    • Division of ResearchKaiser Permanente
  • Rachel A. Whitmer
    • Division of ResearchKaiser Permanente
  • Jennifer Y. Liu
    • Division of ResearchKaiser Permanente
  • Yinghui Miao
    • San Francisco VA Medical Center
    • Division of GeriatricsUniversity of California, San Francisco
  • Priya M. John
    • Section of General Internal Medicine, Department of MedicineUniversity of Chicago
  • Dean Schillinger
    • Division of General Internal MedicineUniversity of California, San Francisco
    • Center for Vulnerable PopulationsThe University of California San Francisco
    • California Department of Public HealthCalifornia Diabetes Program
Original Research

DOI: 10.1007/s11606-012-2132-3

Cite this article as:
Sudore, R.L., Karter, A.J., Huang, E.S. et al. J GEN INTERN MED (2012) 27: 1674. doi:10.1007/s11606-012-2132-3

ABSTRACT

BACKGROUND

Reducing symptom burden is paramount at the end-of-life, but typically considered secondary to risk factor control in chronic disease, such as diabetes. Little is known about the symptom burden experienced by adults with type 2 diabetes and the need for symptom palliation.

OBJECTIVE

To examine pain and non-pain symptoms of adults with type 2 diabetes over the disease course – at varying time points before death and by age.

DESIGN

Survey follow-up study.

PARTICIPANTS

13,171 adults with type 2 diabetes, aged 30–75 years, from Kaiser Permanente, Northern California, who answered a baseline symptom survey in 2005–2006.

MAIN MEASURES

Pain and non-pain symptoms were identified by self-report and medical record data. Survival status from baseline was categorized into ≤6, >6–24, or alive >24 months.

KEY RESULTS

Mean age was 60 years; 48 % were women, and 43 % were non-white. Acute pain was prevalent (41.8 %) and 39.7 % reported chronic pain, 24.6 % fatigue, 23.7 % neuropathy, 23.5 % depression, 24.2 % insomnia, and 15.6 % physical/emotional disability. Symptom burden was prevalent in all survival status categories, but was more prevalent among those with shorter survival, p < .001. Adults ≥60 years who were alive >24 months reported more physical symptoms such as acute pain and dyspnea, whereas participants <60 years reported more psychosocial symptoms, such as depressed mood and insomnia. Adjustment for duration of diabetes and comorbidity reduced the association between age and pain, but did not otherwise change our results.

CONCLUSIONS

In a diverse cohort of adults with type 2 diabetes, pain and non-pain symptoms were common among all patients, not only among those near the end of life. However, symptoms were more prevalent among patients with shorter survival. Older adults reported more physical symptoms, whereas younger adults reported more psychosocial symptoms. Diabetes care management should include not only good cardiometabolic control, but also symptom palliation across the disease course.

KEY WORDS

palliative carediabetes mellitus type 2quality of life

Supplementary material

11606_2012_2132_MOESM1_ESM.docx (44 kb)
Appendix 1Symptom Assessment* (DOCX 43.6 kb)
11606_2012_2132_MOESM2_ESM.docx (50 kb)
Appendix 2Symptom Burden by Age and Survival Status (DOCX 50.2 kb)

Copyright information

© Society of General Internal Medicine 2012