Almost half of adults with type 2 diabetes report acute and chronic pain, and close to one quarter report neuropathy, fatigue, depression, sleep disturbance and physical or emotional disability, according to a study of more than 13,000 adults conducted by researchers at the San Francisco VA Medical Center, the University of California, San Francisco and the Kaiser Permanente Division of Research in Oakland, Calif. The researchers also found significant rates of shortness of breath, nausea and constipation.
Patients in the study reported significant pain and non-pain symptoms across the entire course of the disease, among all age groups, with prevalence increasing as people neared the end of their lives.
The findings appear in the Journal of General Internal Medicine and were made available online last week at www.SpringerLink.com. According to the authors, it is the largest observational study to assess a full range of pain and non-pain symptoms among patients with type 2 diabetes, and the first to characterize the kinds of symptoms that patients experience.
"Adults living with type 2 diabetes are suffering from incredibly high rates of pain and non-pain symptoms, at levels similar to patients with living with cancer," said lead author Rebecca Sudore, a staff physician at SFVAMC and associate professor of medicine at UCSF.
She noted that tens of millions of Americans have type 2 diabetes.
"The field of diabetes has focused, and rightfully so, on decreasing patients' blood sugar, blood pressure and cholesterol levels in attempt to prevent complications such as cardiovascular disease, kidney failure, amputations and blindness," said Andrew J. Karter, PhD, a principal investigator of the DISTANCE and Diabetes & Aging Studies, and senior research scientist at Kaiser. "However, our observations provide an important wake up call for clinicians to not wait until the latest stages of diabetes to focus on these patient-reported outcomes, but rather to consider early palliative care as part of usual chronic disease management."
Palliative care is specialized medical care for people with serious illness that provides an added layer of support in addition to regular disease management, with the goal of relieving symptoms and improving quality of life, explained Sudore. She noted that other studies suggest that seriously ill patients who receive palliative care live longer with a better quality of life.
"Palliative care has already begun to be woven into the care provided to patients with cancer, heart failure and kidney failure," she said. "Our results highlight the need to expand diabetes management to also include the palliative care model."
The research team surveyed 13,171 adults with diabetes, aged 30 to 75 years, who were enrolled in Kaiser Permanente Northern California and participated in the NIH-funded Diabetes Study of Northern California (DISTANCE) and its ancillary Diabetes & Aging Study.
Adults over the age of 60 reported more physical symptoms such as pain, whereas adults younger than 60 reported more psychosocial symptoms such as fatigue and depression. Symptom burden remained high even after the researchers accounted for other medical illnesses and duration of diabetes. Results were based on self-reported symptoms and chart review.
In type 2 diabetes, the most common form of the disease, patients' blood sugars become chronically elevated, which in turn damages blood vessels and nerves leading to and from the heart, brain, kidneys, gastrointestinal tract, eyes, ears, legs and feet. This damage can lead to serious illness and death.
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