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

• DOI: 10.1007/s11606-012-2132-3
• Publication Date: 2012-08-01T19:27:52Z
• Authors: Rebecca L. Sudore; 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
• Keywords: Male; Aging; Clinical sciences; Comorbidity; Severity of Illness Index; California; 0302 clinical medicine; 7.1 Individual care needs; Musculoskeletal Pain; Sickness Impact Profile; Surveys and Questionnaires; Public health; palliative care; Depression; Pain Research; Diabetes; Middle Aged; Prognosis; 3. Good health; Survival Rate; Mental Health; Disease Progression; Female; Chronic Pain; Type 2; Adult; diabetes mellitus type 2; Clinical Sciences; Risk Assessment; 03 medical and health sciences; Age Distribution; Clinical Research; Health Services and Systems; General & Internal Medicine; Health Sciences; Behavioral and Social Science; Health services and systems; Diabetes Mellitus; Humans; Sex Distribution; Metabolic and endocrine; Aged; Biomedical and Clinical Sciences; Neurosciences; Cross-Sectional Studies; quality of life; Diabetes Mellitus, Type 2; Quality of Life; Management of diseases and conditions; Mind and Body

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.