Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study
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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.
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.
Survey follow-up study.
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.
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.
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.
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.
- Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study
Journal of General Internal Medicine
Volume 27, Issue 12 , pp 1674-1681
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- Print ISSN
- Online ISSN
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- palliative care
- diabetes mellitus type 2
- quality of life
- Industry Sectors
- Rebecca L. Sudore MD (1) (2)
- Andrew J. Karter PhD (3)
- Elbert S. Huang MD, MPH (4)
- Howard H. Moffet MPH (3)
- Neda Laiteerapong MD (4)
- Yael Schenker MD (5)
- Alyce Adams PhD (3)
- Rachel A. Whitmer PhD (3)
- Jennifer Y. Liu MPH (3)
- Yinghui Miao MPH (1) (2)
- Priya M. John MPH (4)
- Dean Schillinger MD (6) (7) (8)
- Author Affiliations
- 1. San Francisco VA Medical Center, 4150 Clement Street #151R, San Francisco, CA, 94121, USA
- 2. Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- 3. Division of Research, Kaiser Permanente, Oakland, CA, USA
- 4. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
- 5. Division of General Internal Medicine, The University of Pittsburgh, Pittsburgh, PA, USA
- 6. Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- 7. Center for Vulnerable Populations, The University of California San Francisco, San Francisco, CA, USA
- 8. California Department of Public Health, California Diabetes Program, Sacramento, CA, USA