Research Update

Doctors, Patients Must Strike Balance Between Disease Management and Quality of Life Issues

Background: Last month, Dr. Elbert Huang, assistant professor of medicine at the University of Chicago, published results of a study in Diabetes Care that reported 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.

We know that a typical diabetes patient takes many medications each day and as the disease progresses, the need for drugs increases, often including insulin shots. Prior to conducting our study, the diabetes community did not formally know how patients felt about the tradeoffs they were making between the medications they take and the quality of life they are giving up, in the short term.

So, we 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. We asked the 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. We asked, for example: would you rather have six years of life in perfect health, or ten years with an amputation?

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.

I received a strong reaction from the diabetes community about the research and have given some thought to the implications. It seems to me that many patients are saying loud and clear that they do not want more medications or drugs. I think the message we physicians must give is that we hear your complaints and they are legitimate but we must balance those issues with the need for effective treatments. After all, I hear from many doctors who feel patients with diabetes are not managed aggressively enough!

It is my hope that more patients can be like one of the survey patients who came by to talk to me after the study was published. This patient told me that the study made him think and talk to his doctor about why he was on all the meds he was on and whether they were all necessary. If this study can lead to thousands of other similar conversations between patients and doctors, then doing the study will be far more meaningful than the results it generated.


Dr. Elbert Huang is a general internist who studies clinical and health care policy issues at the intersection of diabetes, aging, and health economics. His research examines the constraints, either clinical or financial, that health care providers encounter when caring for patients with chronic diseases. His main research focus is in the area of medical decision making for elderly patients with type 2 diabetes where uncertainty exists regarding how to best individualize diabetes treatments based on clinical parameters and patient preferences.