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.
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.
Authors: Alexander K Smith; Irena Stijacic Cenzer; Sara J Knight; Kathleen A Puntillo; Eric Widera; Brie A Williams; W John Boscardin; Kenneth E Covinsky Journal: Ann Intern Med Date: 2010-11-02 Impact factor: 25.391
Authors: Howard H Moffet; Melissa M Parker; Urmimala Sarkar; Dean Schillinger; Alicia Fernandez; Nancy E Adler; Alyce S Adams; Andrew J Karter Journal: Am J Manag Care Date: 2011-05 Impact factor: 2.229
Authors: Jennifer S Temel; Joseph A Greer; Alona Muzikansky; Emily R Gallagher; Sonal Admane; Vicki A Jackson; Constance M Dahlin; Craig D Blinderman; Juliet Jacobsen; William F Pirl; J Andrew Billings; Thomas J Lynch Journal: N Engl J Med Date: 2010-08-19 Impact factor: 91.245
Authors: Robert G Fassett; Iain K Robertson; Rose Mace; Loren Youl; Sarah Challenor; Rosalind Bull Journal: Nephrology (Carlton) Date: 2011-01 Impact factor: 2.506
Authors: Jeff K Vallance; Elisabeth A H Winkler; Paul A Gardiner; Genevieve N Healy; Brigid M Lynch; Neville Owen Journal: Prev Med Date: 2011-07-23 Impact factor: 4.018
Authors: Neda Laiteerapong; Andrew J Karter; Jennifer Y Liu; Howard H Moffet; Rebecca Sudore; Dean Schillinger; Priya M John; Elbert S Huang Journal: Diabetes Care Date: 2011-06-02 Impact factor: 19.112
Authors: Vijaya Kancherla; John L Elliott; Birju B Patel; N Wilson Holland; Theodore M Johnson; Anjali Khakharia; Lawrence S Phillips; Godfrey P Oakley; Camille P Vaughan Journal: J Am Geriatr Soc Date: 2017-02-09 Impact factor: 5.562
Authors: Howard H Moffet; E Margaret Warton; Melissa M Parker; Jennifer Y Liu; Courtney R Lyles; Andrew J Karter Journal: Inf Secur Comput Fraud Date: 2014
Authors: Patricia M Kluding; Mamatha Pasnoor; Rupali Singh; Linda J D'Silva; Min Yoo; Sandra A Billinger; Joseph W LeMaster; Mazen M Dimachkie; Laura Herbelin; Douglas E Wright Journal: Phys Ther Date: 2014-10-02
Authors: Richard W Grant; Courtney Lyles; Connie S Uratsu; Michelle T Vo; Elizabeth A Bayliss; Michele Heisler Journal: Ann Fam Med Date: 2019-03 Impact factor: 5.166
Authors: Lucas M Donovan; Lan Yu; Suzanne M Bertisch; Daniel J Buysse; Michael Rueschman; Sanjay R Patel Journal: Chest Date: 2019-11-27 Impact factor: 9.410