Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study
ABSTRACT 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. 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. Survey follow-up study. 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. 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. 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. 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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ABSTRACT: Abstract Research addressing the burden, assessment, and management of nonpain symptoms associated with advanced illness in older adults is limited. While nonpain symptoms such as fatigue, sleep, dyspnea, anxiety, depression, cognitive impairment, nausea, and anorexia-cachexia are commonly noted by patients and clinicians, research quantifying their effects on quality of life, function, and other outcomes are lacking and there is scant evidence regarding management. Most available studies have focused on relatively narrow conditions (e.g., chemotherapy-induced nausea) and there are almost no data relevant to patients with multiple morbidities or multiple concurrent symptoms. Assessment and treatment of nonpain symptoms in older adults with serious illness and multiple comorbidities is compromised by the lack of data relevant to their care. Recommended research priorities address the documented high prevalence of distressing symptoms in older adults with serious illness, the unique needs of this population due to coexistence of multiple chronic conditions along with physiologic changes related to aging, the lack of evidence for effective pharmacologic and nonpharmacologic interventions, and the need for validated measures that are relevant across multiple care settings.Journal of palliative medicine 07/2013; DOI:10.1089/jpm.2013.9484
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ABSTRACT: With the aging of the population and continuing advances in health care, patients seen in the primary care setting are increasingly complex. At the same time, the number of screening and chronic condition management tasks primary care providers are expected to cover during brief primary care office visits has continued to grow. These converging trends mean that there is often not enough time during each visit to address all of the patient's concerns and needs, a significant barrier to effectively providing patient-centered care. For complex patients, prioritization of which issues to address during a given visit must precede discrete decisions about disease-specific treatment preferences and goals. Negotiating this process of setting priorities represents a major challenge for patient-centered primary care, as patient and provider priorities may not always be aligned. In this review, we present a synthesis of recent research on how patients and providers negotiate the visit process and describe a conceptual model to guide innovative approaches to more effective primary care visits for complex patients based on defining visit priorities. The goal of this model is to inform interventions that maximize the value of available time during the primary care encounter by facilitating communication between a prepared patient who has had time before the visit to identify his/her priorities and an informed provider who is aware of the patient's care priorities at the beginning of the visit. We conclude with a discussion of key questions that should guide future research and intervention development in this area.12/2013; 1(s 3–4):117–122. DOI:10.1016/j.hjdsi.2013.07.008
Article: Nonglycemic Targets in Diabetes[Show abstract] [Hide abstract]
ABSTRACT: New treatment target guidelines for the treatment of hypertension, lipids, and nephropathy have recently been released for patients with diabetes, including new treatment targets for geriatric patients. In general, these guidelines have simplified care for patients with diabetes and for their providers. This article reviews these targets in detail. Also, because mental health is key to treatment adherence, the authors summarize the treatment guidelines for important diagnostic and treatment issues related to mental health. Finally, the authors include clinical target recommendations related to driving safety for patients with diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.Medical Clinics of North America 01/2014; 99(1). DOI:10.1016/j.mcna.2014.08.014