Journal of General Internal Medicine

, Volume 27, Issue 12, pp 1674–1681 | Cite as

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

  • Rebecca L. SudoreEmail author
  • Andrew J. Karter
  • Elbert S. Huang
  • Howard H. Moffet
  • Neda Laiteerapong
  • Yael Schenker
  • Alyce Adams
  • Rachel A. Whitmer
  • Jennifer Y. Liu
  • Yinghui Miao
  • Priya M. John
  • Dean Schillinger
Original Research



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.


palliative care diabetes mellitus type 2 quality of life 




Dr. Sudore was supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, the San Francisco Research Enhancement Award Program. This work was performed with support by the National Institutes of Health (NIH) National Institutes of Diabetes, Digestive and Kidney Diseases (NIDDK) for the Diabetes and Aging Study (RO1-DK-081796) and the Diabetes Study of Northern California (DISTANCE) (R01-DK-065664, R01-DK080726 and R01-HD46113). Dr. Laiteerapong was supported by the Agency for Healthcare Research and Quality, T32-HS000084 and the NIDDK F32-DK-089973. Dr. Laiteerapong, Ms. John, and Dr. Huang are members of the NIDDK Diabetes and Research Training Center at the University of Chicago (grant P60-DK-20595). Investigators were also supported by NIDDK Centers for Diabetes Translation Research at Kaiser Permanente and University of California, San Francisco (P30 DK092924) and the University of Chicago (P30 DK092949). The funding organization had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

Prior presentations


Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

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


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Rebecca L. Sudore
    • 1
    • 2
    Email author
  • Andrew J. Karter
    • 3
  • Elbert S. Huang
    • 4
  • Howard H. Moffet
    • 3
  • Neda Laiteerapong
    • 4
  • Yael Schenker
    • 5
  • Alyce Adams
    • 3
  • Rachel A. Whitmer
    • 3
  • Jennifer Y. Liu
    • 3
  • Yinghui Miao
    • 1
    • 2
  • Priya M. John
    • 4
  • Dean Schillinger
    • 6
    • 7
    • 8
  1. 1.San Francisco VA Medical CenterSan FranciscoUSA
  2. 2.Division of GeriatricsUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Division of ResearchKaiser PermanenteOaklandUSA
  4. 4.Section of General Internal Medicine, Department of MedicineUniversity of ChicagoChicagoUSA
  5. 5.Division of General Internal MedicineThe University of PittsburghPittsburghUSA
  6. 6.Division of General Internal MedicineUniversity of California, San FranciscoSan FranciscoUSA
  7. 7.Center for Vulnerable PopulationsThe University of California San FranciscoSan FranciscoUSA
  8. 8.California Department of Public HealthCalifornia Diabetes ProgramSacramentoUSA

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