New Standards beyond Glucose Control Recommended

The focus on diabetes treatment has been controlling blood sugars, blood pressure and cholesterol levels to prevent complications. But now researchers suggest palliative care, or preventing suffering, is just as important for tens of millions of people living with the disease who also suffer from acute and chronic pain, emotional and physical disability, fatigue, depression, sleep disturbance and other physical complaints.

According to the study authors, almost half of people with diabetes suffer from acute and chronic pain. A common source of pain is from diabetic neuropathy that can also lead to poor quality sleep. Nearly one-fourth of diabetics suffer from depression, fatigue and emotional and physical disability, making it important to adopt new standards of care.

Study author Dr. Rebecca Sudore, a staff physician at the San Francisco VA Medical Center, and associate professor of medicine at University of California, San Francisco, said in a new release that diabetics suffer from "incredibly high rates of pain and non-pain symptoms, at levels similar to patients with living with cancer."

The study, which was a collaborative effort from researchers at the San Francisco VA Medical Center, the University of California, San Francisco and the Kaiser Permanente Division of Research in Oakland, CA that included more than 13,000 adults, also found diabetics suffer from significant levels of shortness of breath, nausea and constipation.

The investigation is the first observational study to characterize what type of symptoms patients living with diabetes experience across the entire course of the disease.

Andrew J. Karter, PhD, a principal investigator of the DISTANCE and Diabetes & Aging Studies, and senior research scientist at Kaiser said, "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."

As the disease progresses, symptoms get worse, making it important to intervene early to prevent suffering.

Sudore points out that studies have shown relieving symptoms for patients with serious diseases – such as cancer, kidney disease and heart failure – is shown to extend and improve quality of life. She notes it's time to expand the role of palliative care to include diabetes.

The researchers surveyed 13,171 adults with diabetes, aged 30 to 75 years. Fatigue and depression were most commonly reported by diabetes under age 60; adults over 60 living with the disease reported more pain and other physical symptoms.

The study, if heeded by clinicians, would mean better quality of care for people living with type 2 diabetes. Adding early palliative care into diabetes management would also mean improved quality of life for tens of millions with the disease.

Journal of General Internal Medicine: "Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study" Rebecca L. Sudore, et al. DOI: 10.1007/s11606-012-2132-3 August 3, 2012