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Senior Citizen Health & Medicine
Some Diabetics Would Sacrifice Years of Life to
Avoid Treatment, Complications
 Large
proportions with type-2 diabetes have poorly controlled glucose (20%),
blood pressure (33%) and cholesterol (40%)
Sept. 27, 2007 Between 10 and 18 percent of
patients with diabetes said they are willing to give up 8 of 10 years of
healthy life to avoid life with treatments for the disease, which is a
major chronic illness for senior citizens.
Between 12 and 50 percent of diabetes patients also
said they are willing to give up 8 of 10 years of life in perfect health
to avoid life with the complications of diabetes.
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Many patients with diabetes say that the
inconvenience and discomfort of constant therapeutic vigilance,
particularly multiple daily insulin injections, has as much impact on
their quality of life as the burden of intermediate complications,
researchers from the University of Chicago report in the October 2007
issue of Diabetes Care.
A typical diabetes patient takes many medications
each day, including two or three different pills to control blood sugar
levels, one or two to lower cholesterol, two or more to reduce blood
pressure, a daily aspirin to prevent blood clots, plus diet and
exercise. As the disease progresses, the drugs increase, often including
insulin shots.
"The people who care for patients with a chronic
disease like diabetes think about that disease and about preventing
long-term complications," said study author Elbert Huang, MD, assistant
professor of medicine at the University of Chicago.
"The people who have a chronic disease think about
their immediate lives, which includes the day-to-day costs and
inconvenience of a multi-drug regimen. The consequences are often poor
compliance, which means long-term complications, which will then require
more medications."
 Despite
growing reliance on such complex multi-drug regimens, large proportions
of patients with type-2 diabetes continue to have poorly controlled
glucose (20%), blood pressure (33%) and cholesterol (40%).
"This tells us that we need to find better, more
convenient ways to treat chronic illness," Huang said. "It is hard to
convince some patients to invest their time and effort now in rigorous
adherence to a complex regimen with no immediate reward, just the
promise of better health years from now," Huang said.
"This certainly rings true to me," agreed diabetes
specialist Louis Philipson, MD, PhD, professor of medicine at the
University of Chicago, who was not part of the research team. "Some
patients, if you judge by their behavior, would rather be well on the
road to future blindness, kidney failure or amputations then work hard
now at their diabetes."
Huang and colleagues conducted hour-long
face-to-face interviews with a multiethnic sample of 701 adult, type-2
diabetes patients attending Chicago area clinics between May 2004 and
May 2006. They asked patients to rank the benefits of various treatments
and the daily quality-of-life burdens of diabetes-associated
complications.
Patients were asked to express their preferences in
a series of trade-offs. The surveyors asked, for example: would you
rather have six years of life in perfect health, or ten years with an
amputation"
As expected, patients were most distressed by
end-stage complications, especially kidney failure, a major stroke or
blindness. They were slightly less concerned about amputations or
diabetic retina damage, and still less about angina, diabetic nerve or
kidney damage.
The complications that diabetics dread most are
>> major stroke (0.31 rating),
>> kidney dialysis (0.35),
>> blindness (0.38),
>> diabetic eye disease (0.53),
>> amputation (0.55),
>> chest pain (0.64)
>> mild kidney disease (0.64),
>> neuropathy (0.66) and
>> mild stroke (0.7).
Patients also disliked intensive treatments,
especially intensive glucose control, with multiple daily insulin
injections, and what the authors called comprehensive diabetes care,
which was intensive glucose control plus other medications.
On average, patients ranked the burden of
comprehensive diabetes care and intensive glucose control as equal to
the burden of angina, diabetic nerve damage or kidney damage.
Patients varied widely in how they ranked
treatments and complications. Those who had experience with a specific
medication or complication saw them as having less of an impact on
quality of life than those without such direct experience.
But many patients found both complications and
treatment onerous.
The existing burden of treatment may even increase
when results from the ongoing ACCORD trial are announced in 2010, said
Huang. "This trial may produce evidence for even greater use of
medications to try to prevent complications," he said
"Our study results show that taking multiple
medications on a routine basis represents a significant burden for many
patients," the authors conclude. "Quality of life related to treatments
will be likely to improve if we can simplify or modify current
treatments through treatment innovations."
Until specialists find ways to do that, Philipson
added, "physicians need to be able to spend more time with patients."
This includes finding ways to bill appropriately for phone- and
web-based interactions. "We also need more ancillary services like
psychiatric social workers and diabetes educators to meet with
patients," he added. "That could save the health care system a ton of
money, even without developing new drugs or treatments. But we have to
do that as well."
Editors Notes:
The Centers for Disease Control and Prevention, the
National Institute of Aging, the National Institute of Diabetes and
Digestive and Kidney Disease, and the Chicago Center of Excellence in
Health Promotion Economics funded the research.
Additional authors were Sydney Brown, Bernard
Ewigman, Edward Foley and David Meltzer of the University of Chicago.
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