Washington: In a study of more than 13,000 adults, almost half of adults with type 2 diabetes reported acute and chronic pain, and close to one quarter reported neuropathy, fatigue, depression, sleep disturbance and physical or emotional disability.
The study was 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, CA.
The researchers also found significant rates of shortness of breath, nausea and constipation.
They suggested that palliative care become part of standard management of the disease.
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.
“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 Dr. Rebecca Sudore, a staff physician at SFVAMC and associate professor of medicine at UCSF.
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, according to the researchers.
“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 and 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,” he suggested.
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 Dr. 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. Our results highlight the need to expand diabetes management to also include the palliative care model,” she said.
For their study, 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 and 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.
The findings appeared in the Journal of General Internal Medicine.