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Your Treatment…Or Your Life?

Jan Chait

October 16, 2007

Ever since the report came out a couple of weeks ago that people with Type 2 diabetes would trade years of life for less-intensive treatment of diabetes, I’ve been scratching my head. They also ranked putting up with comprehensive diabetes care as being more onerous than certain complications.

In case you missed it (or need a review), researchers studied 701 adults who’d had Type 2 diabetes for an average of 9.9 years and who attended clinics in the Chicago area. The researchers found that the group believed:

• Intensive control of diabetes—plus taking care of blood pressure and other risk factors that go along with diabetes—was similar to having angina, nerve damage, or kidney damage. (I should point out here that 23% said they had some type of microvascular complication and 30% reported having cardiovascular complications.)
• Quality of life was rated best by those who managed their diabetes with diet and exercise.
• Comprehensive diabetes treatment, which included intensive blood glucose control plus medications to maintain optimum blood pressure, cholesterol, and so on, ranked lowest on the quality-of-life scale.
• The prospect of taking multiple insulin injections was ranked worse than taking multiple oral medicines.
• Up to 18% of the study group said they’d rather lose 8-10 years of perfect health than have to put up with diabetes treatments.
• Up to 50% would rather lose that many years of perfect health if they could just avoid complications altogether.

Personally, I don’t like to have a cold; I don’t even want to think about diabetic complications. Nearly 22 years after diagnosis, and probably several years of Type 2 diabetes before that, I can still pass a filament test on my feet. My microalbumin level is slightly elevated, but has been for years. I’ve had some of that soft tissue damage we tend to be prone to, in the form of shoulder impingements—both shoulders at the same time. (It’s short of frozen shoulder but, basically, if you reach too far, the intense pain lets you know it, you need help getting dressed, and it’s difficult to find a comfortable sleeping position.)

I didn’t have access to the actual report, which was published in the October issue of Diabetes Care, but I wonder how far the researchers went in explaining neuropathy, or nerve damage. Did they stop at numb feet, or did they get into silent heart attacks and gastroparesis, which is where your stomach stops working? I just tend to wonder about things like that, is all.

Diabetes care can be a pain in the hiney. And it’s not just the “care and feeding” of diabetes, but all of those other things you need to do to lower your risk of stroke, heart attacks, blindness, kidney failure, and so on. It’s also expensive—and not getting any cheaper—as new, and more costly, drugs come onto the market. You tend to visit a lot of doctors, too. I swear I have a doctor for every part of my body. I’m one of the fortunate ones, in that our household income is high enough and our medical insurance good enough that we can afford for me to have diabetes.

It’s also difficult to think down the road to what could be, especially if there seems to be nothing wrong with you now. Plus, even with fantastic control, there are no promises. You can have well-controlled diabetes and still get complications, or you can ignore the diabetes and make it through life with no related problems.

But even if you don’t think about the long term, what about right now? Poorly controlled diabetes isn’t any fun. I remember being afraid to drive anywhere because I could fall asleep at any time. I had a recurring vaginal infection. I was s-o-o-o tired I could barely move. I couldn’t get enough water to drink. I was hungry all the time.

When I got my blood glucose under control, I was energetic, the yeast infection went away, the hunger and thirst departed. Heck, I even felt like having sex again! I resisted in the beginning. I didn’t like taking pills (still don’t). I was on a two-injections-per-day regimen that involved a lot of clock-watching. It got better when I started doing multiple injections and fantastic when I started using an insulin pump. My life improved even more when I got to the point I could put myself on “automatic pilot” when it came to wrestling the Diabeastie into some semblance of order.

I still get burned out on occasion but can, eventually, get myself back on track.

But wait. What did this study conclude?

“Patient concerns may still be allayed through early patient education, incorporating patient preferences into treatment decisions, and by acknowledging quality-of-life concerns in public health efforts.”

Now where have I heard that before? Ah, yes. Didn’t I touch on that in a blog entry on September 25? In other words, told ya so!

And I didn’t even have to study 701 people.

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