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Beyond Blood Sugar: Is it time to expand the focus of diabetes care?

September 4, 2012 in News

What would you say is your health care provider’s main focus in treating you for diabetes?

If you are like most diabetics in the United States, you probably answered something fairly close to “preventing complications by managing your blood sugar, cholesterol levels, and/or your blood pressure.”

Preventing or delaying complications has been the focus of diabetes treatment for many years. Managing blood sugar, cholesterol, and blood pressure is crucial to maintaining overall health and quality of life. However, results from a recently published study are prompting some experts to suggest that there is a missing piece that could be just as important to those living with the disease as the prevention of complications.

You may be familiar with the term “palliative care.” In the media, the term is used most frequently in relation to discussions of cancer and cancer treatments. Palliative care refers to treatments whose focus is simply to prevent or alleviate suffering. According to Dr. Rebecca Sudore of the San Francisco VA Medical Center, palliative care may be just as necessary for diabetes patients as it is for patients dealing with cancer, kidney disease, or heart failure.

The study that is prompting researchers to call for addition of palliative care to the current clinical standards for diabetes management was a joint effort of the San Francisco VA Medical Center, the University of California, San Francisco and the Kaiser Permanente Division of Research in Oakland. This study included more than 13,000 adults between ages 30 and 75, and attempted to characterize the symptoms experienced by persons with diabetes over the entire course of the disease. It is the first observational study conducted on diabetes symptoms throughout its progression.

According to study author Dr. Rebecca Studore, a physician at San Francisco VA Medical Center, people with diabetes suffer from very high rates of both painful and non-painful symptoms that can affect quality of life, at levels of discomfort similar to those experienced by patients with cancer.

The researchers found that one quarter of the diabetics studied suffered from depression, fatigue, and emotional or physical disability. Almost half experienced both acute and chronic pain, often linked to diabetic neuropathy. The pain experienced by the study subjects often resulted in sleep difficulties, causing a cascade of other symptoms as a result. Other frequently reported symptoms were shortness of breath, nausea, and constipation; researchers concluded that all symptoms worsened as diabetes progresses. Persons under age 60 were more likely to report difficulty with fatigue and depression; adults over age 60 struggled more with pain and other physical symptoms.

All of these symptoms can reduce quality of life, and can make diabetes self-management much more difficult. Many studies have shown that using palliative care to relieve symptoms for patients with other diseases, such as cancer and heart failure, can extend and improve quality of life. Dr. Sudore feels that it is time to include diabetes in the list of conditions for which a focus on palliative care is essential.

The timing of palliative care matters, just as timing matters when using blood sugar, cholesterol, and blood pressure management to prevent diabetes complications. Study author Andrew J. Karter, PhD, of Kaiser Permanente, commented that clinicians often do not turn to palliative care options for diabetes patients until late in the progression of the disease. Intervening early as part of usual chronic disease management could do much more to alleviate overall suffering.

This doesn’t mean that managing your blood sugar, cholesterol, and blood pressure is any less vital. Careful self-management can prevent many of the painful and problematic complications of diabetes less likely to occur, and can reduce the impact of other symptoms as well. Palliative care, started early and combined with the standards of care already in place, offers the potential to further enhance quality of care and quality of life. This form of care can reduce suffering, but cannot reduce the risk of diabetes complications without the self-management and lifestyle behaviors you are already familiar with.

If you are suffering from chronic pain, trouble sleeping, constipation, nausea, or any of the other symptoms mentioned… have you spoken with your doctor about these symptoms and the effect they are having on your life? Even if your symptoms weren’t mentioned in this post, even if you are not sure they are related to your diabetes, make sure that you bring them to your health care team’s attention. Anything that makes getting through the day harder, or that could impact your ability to manage your diabetes, is an important piece of information for those who are treating you. There may be treatments or therapies available that could alleviate your symptoms, even if they don’t directly treat the cause.

If you’d like to read more, you can read the original article via EmaxHealth.

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