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Cited by 105Palliative Care and End-of-Life IssuesChronic Disease Management StrategiesDiabetes Management and Education

Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study

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Sudore, Rebecca L., Karter, Andrew J., Huang, Elbert S., Moffet, Howard H., Laiteerapong, Neda, Schenker, Yael, Adams, Alyce, Whitmer, Rachel A. +4 more·2012·Journal of General Internal Medicine
DOI 10.1007/s11606-012-2132-3PMC PMC3509316
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Abstract

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.

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  • These geriatric syndromes and polypharmacy may impact older adults' diabetes self-management abilities and quality of life if left unaddressed.

    “These conditions may impact older adults' diabetes self-management abilities and quality of life if left unaddressed (2,6,7).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [6]

    The Background (page unavailable) links diabetes with impaired quality of life, and the Conclusions call for symptom palliation across the disease course. The paper does not establish that geriatric syndromes or polypharmacy impair older adults’ diabetes self-management abilities; the quality-of-life support is broader than the specific claim. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • These conditions may impact older adults' diabetes self-management abilities and quality of life if left unaddressed.

    “These conditions may impact older adults' diabetes self-management abilities and quality of life if left unaddressed (2,6,7).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [6]

    The Background links diabetes with impaired quality of life, and the Discussion recommends addressing symptoms to maximize quality of life. The paper does not establish that these conditions affect older adults’ diabetes self-management abilities. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • These conditions may affect older adults' diabetes self-management abilities and quality of life, particularly if unaddressed.

    “These conditions may affect older adults’ diabetes self-management abilities and quality of life, particularly if unaddressed, and older adults with diabetes often require greater caregiver support than those without diabetes (2,9–11).”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [9]

    The Background links diabetes with impaired quality of life, and the Discussion recommends symptom palliation to maximize quality of life. The paper does not say that these conditions affect older adults’ diabetes self-management abilities, so that part of the attributed claim is unsupported. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Older adults with diabetes often require greater caregiver support than those without diabetes.

    “These conditions may affect older adults’ diabetes self-management abilities and quality of life, particularly if unaddressed, and older adults with diabetes often require greater caregiver support than those without diabetes (2,9–11).”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [9]

    The Background and Discussion describe symptom burden and propose palliative services for adults with type 2 diabetes, but do not address caregiver support. Searches for caregiver support and assistance with self-management found no comparison between older adults with and without diabetes. The cited claim cannot be verified from our copy. (LLM, conf=0.76)

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Authors
Sudore, R. L., Karter, A. J., Huang, E. S., Moffet, H. H., Laiteerapong, N., Schenker, Y., Adams, A., Whitmer, R. A., Liu, J. Y., Miao, Y., John, P. M., & Schillinger, D.
Affiliations
  • San Francisco VA Medical Center (US)
  • Kaiser Permanente (US)
  • University of Chicago (US)
  • University of Pittsburgh (US)
  • California Department of Public Health (US)
Corresponding author
Sudore, Rebecca L.
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2012-08-02
Volume
27
Issue
12
Pages
1674-1681
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-012-2132-3
PMC
PMC3509316
OpenAlex
W2144393286
Cited by
105
References
6
Citations by year
2026: 6 · 2025: 11 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 9 · 2020: 11 · 2019: 13 · 2018: 6 · 2017: 7 · 2016: 7 · 2015: 7 · 2014: 5 · 2013: 3
FWCI
4.64
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Kaiser Permanente
  • Office of Research and Development
  • Health Services Research and Development
  • University of Chicago
  • National Institutes of Health (HS000084, DK092924)
  • Agency for Healthcare Research and Quality (T32HS000084, HS000084)
  • University of California, San Francisco
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK080726, P60DK20595, DK092949, F32DK089973, R01DK081796, P60DK020595, K23DK097283, R01DK065664, P30DK092949, P30DK092924)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01-HD-46113, R01HD046113)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
type 2 diabetes, symptom burden, pain, chronic pain, fatigue, neuropathy, depression, insomnia, dyspnea, physical disability, end-of-life care, symptom relief, aging, survival time, psychosocial symptoms, somatic symptoms
MeSH terms
Adult, Aged, Aging, California, Cross-Sectional Studies, Depression, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Prognosis, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Comorbidity, Survival Rate, Age Distribution, Sex Distribution, Sickness Impact Profile, Disease Progression, Risk Assessment, Musculoskeletal Pain

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