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

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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.

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Acknowledgments

Funders

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.

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Conflict of Interest

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

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Authors and Affiliations

  1. San Francisco VA Medical Center, 4150 Clement Street #151R, San Francisco, CA, 94121, USA

    Rebecca L. Sudore MD & Yinghui Miao MPH

  2. Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA

    Rebecca L. Sudore MD & Yinghui Miao MPH

  3. Division of Research, Kaiser Permanente, Oakland, CA, USA

    Andrew J. Karter PhD, Howard H. Moffet MPH, Alyce Adams PhD, Rachel A. Whitmer PhD & Jennifer Y. Liu MPH

  4. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA

    Elbert S. Huang MD, MPH, Neda Laiteerapong MD & Priya M. John MPH

  5. Division of General Internal Medicine, The University of Pittsburgh, Pittsburgh, PA, USA

    Yael Schenker MD

  6. Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA

    Dean Schillinger MD

  7. Center for Vulnerable Populations, The University of California San Francisco, San Francisco, CA, USA

    Dean Schillinger MD

  8. California Department of Public Health, California Diabetes Program, Sacramento, CA, USA

    Dean Schillinger MD

Authors
  1. Rebecca L. Sudore MD
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  12. Dean Schillinger MD
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Corresponding author

Correspondence to Rebecca L. Sudore MD.

Electronic supplementary material

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Appendix 1

Symptom Assessment* (DOCX 43.6 kb)

Appendix 2

Symptom Burden by Age and Survival Status (DOCX 50.2 kb)

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Sudore, R.L., Karter, A.J., Huang, E.S. et al. Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study. J GEN INTERN MED 27, 1674–1681 (2012). https://doi.org/10.1007/s11606-012-2132-3

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  • DOI: https://doi.org/10.1007/s11606-012-2132-3

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