San Francisco VA Medical Center, 4150 Clement Street #151R, San Francisco, CA 94121, USA.
J Gen Intern Med. 2012 Dec;27(12):1674-81. doi: 10.1007/s11606-012-2132-3. Epub 2012 Aug 2.
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.
在生命末期，减轻症状负担至关重要，但通常被认为次于慢性病（如糖尿病）的风险因素控制。对于 2 型糖尿病成年人的症状负担以及对症状缓解的需求知之甚少。
检查 2 型糖尿病成年人在疾病过程中的疼痛和非疼痛症状 - 在死亡前的不同时间点和按年龄划分。
调查随访研究。
来自加利福尼亚州北部 Kaiser Permanente 的 13171 名年龄在 30-75 岁之间的 2 型糖尿病成年人，他们在 2005-2006 年回答了基线症状调查。
疼痛和非疼痛症状通过自我报告和病历数据确定。从基线开始的生存状态分为≤6、>6-24 或>24 个月存活。
平均年龄为 60 岁；48%为女性，43%为非白人。急性疼痛普遍存在（41.8%），39.7%报告慢性疼痛，24.6%疲劳，23.7%神经病，23.5%抑郁，24.2%失眠，15.6%身体/情绪残疾。在所有生存状态类别中都存在症状负担，但在生存时间较短的患者中更为普遍，p<0.001。年龄≥60 岁且>24 个月存活的成年人报告更多的身体症状，如急性疼痛和呼吸困难，而年龄<60 岁的参与者报告更多的心理社会症状，如情绪低落和失眠。调整糖尿病持续时间和合并症减少了年龄与疼痛之间的关联，但没有改变我们的结果。
在一个多元化的 2 型糖尿病成年人队列中，疼痛和非疼痛症状在所有患者中都很常见，不仅在生命末期。然而，症状在生存时间较短的患者中更为普遍。老年患者报告更多的身体症状，而年轻患者报告更多的心理社会症状。糖尿病的护理管理不仅应包括良好的心血管代谢控制，还应包括整个疾病过程中的症状缓解。
