"Whole patient" approach needed in diabetes care

Older patients often have more than one chronic condition and need guidance to prioritize self-care, according to a new study.

By Susan J. Landers, AMNews staff. Dec. 24/31, 2007.

Washington -- Diabetes by itself is hard enough to manage effectively, but try adding another one, two or three chronic diseases, and the complexities escalate.

Plus, ineffective management of some of these other diseases may be standing in the way of good diabetes control. Researchers in a recent study recommended physicians consider the "whole patient" when devising treatments and advise patients that their chronic conditions may, in fact, be related.

The study, which is in the December Journal of General Internal Medicine, found that 92% of 1,900 older patients queried had at least one other chronic disease in addition to their diabetes, and half had three or more additional diseases. One researcher also speculated that those high numbers are probably underestimates.

The study concluded that patients may neglect their diabetes care and increase their risk for stroke because of the competing demands posed by these simultaneous chronic diseases. The likelihood of this scenario went up with the number and severity of co-existing diseases.

The findings underscore the need to treat the whole patient, because successfully managing one chronic disease, in this case diabetes, could depend on how effectively a patient is managing another. If a patient had arthritis, for example, he or she can continue to exercise, researchers said.

Determining how best to meet these overlapping needs was a driving force behind the research, said the principal investigator, Eve Kerr, MD, MPH, associate director for the VA Ann Arbor Health Services Research and Development Center for Clinical Management Research and associate professor of internal medicine at the University of Michigan Medical School in Ann Arbor.