Many patients with diabetes might prefer to have some risk of minor complications from the disease than to live life saddled with the rigors of comprehensive diabetes management, according to a survey conducted by researchers at the University of Chicago.
In their 1-hour, face-to-face survey interviews with 701 patients with diabetes, investigators found that patients certainly preferred life with treatment to life with complications, Dr. Elbert S. Huang, of the section of general internal medicine at the University of Chicago, and his colleagues reported. But they also found that patients perceived comprehensive diabetes care as having many negative impacts on quality of life—impacts that they rated as about equal to a number of intermediate complications (Diabetes Care 2007;30:1–6).
The researchers described comprehensive care to the study subjects as management that entailed cholesterol-lowering drugs, aspirin, intensive blood pressure control (perhaps with more than one agent), intensive glucose control (perhaps with insulin and oral agents, and close monitoring), and diet and exercise.
The patients ranked intensive control and comprehensive control significantly lower than conventional control. And, the mean rating for comprehensive care was not statistically different from the ratings for angina, diabetic neuropathy, and diabetic nephropathy. The mean rating for intensive therapy, which was demanding but not quite as taxing as comprehensive care, was similar to that of diabetic neuropathy.
Despite those overall findings, Dr. Huang noted that there was much variation in the way the patients answered the questions. The majority actually rated life with treatments as being close to perfect health, and only 18% rated life with treatments as being a significant burden on quality of life.
The study was conducted, Dr. Huang said, because although numerous studies have shown that intensive diabetes control reduces complications and much effort and money is expended to encourage intensive management, at least 20% of patients continue to have poor glycemic control, 33% have suboptimal blood pressure, and 40% have high cholesterol.
The survey may give some insight into why patients with diabetes so often do not meet recommended treatment targets, he said.
The study used a quantitative scale to rate patient preferences, or “utilities,” so answers about treatments and complications could be compared.
The heterogeneity of responses indicates that doctors need to talk to their patients in the clinic and share decision making when making treatment plans, Dr. Huang said.