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Targeting symptoms as well as risks may benefit patients with diabetes
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A high prevalence of pain and other symptoms in a cohort of patients with diabetes have prompted researchers to recommend incorporating symptom palliation into diabetes management.
Current diabetes management and quality improvement efforts have generally targeted risk factor control and “the need for a palliative model of care has not yet been established,” the researchers wrote in the Journal of General Internal Medicine.
Using self-reported data and medical records, Rebecca L. Sudore, MD, of the San Francisco VA Medical Center, and colleagues examined the pain and nonpain symptoms of 13,371 adults (48% women) aged 30 to 75 years with diabetes. The patients’ baseline symptom surveys were previously recorded from 2005 to 2006 as part of the Diabetes Study of Northern California (DISTANCE) from Kaiser Permanente.
According to data, 41.8% of patients reported acute pain and 39.7% reported chronic pain. Other symptoms included fatigue (24.6%), neuropathy (23.7%), depression (23.5%), insomnia (24.2%) and physical/emotional disability (15.6%).
Patient survival status from baseline was categorized into three categories: ≤6 months, >6 to 24 months, or alive <24 months. Within 24 months of the survey, 279 patients (2%) died (51 patients within ≤6 months and 228 patients within >6 to 24 months), researchers wrote.
Causes of death included cardiovascular complications (32.3%), cancer (30.9%), endocrine-related causes (14.9%), pulmonary (6.5%), neurologic (3.6%), infections (1.5%) and renal (0.7%). The remaining deaths were a result of accidents, homicides and suicides (9.6%).
“In this diverse cohort of adults with type 2 diabetes, both pain and nonpain symptoms were common among all patients, not only among those near the end of their life. However, symptoms were more prevalent among patients with shorter survival,” researchers wrote.
Sudore and colleagues said diabetes care management efforts should include palliative services for patients with type 2 diabetes across the disease course to improve quality-of-life outcomes.
Disclosure: The researchers report no relevant financial disclosures.
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