A study published in the December, 2007 issue of the Journal of General Internal Medicine suggests that diabetes patients suffering concurrently from other diseases should be treated on a “whole patient” basis.

The study, authored by a team from the University of Michigan Health System and the VA Ann Arbor Healthcare System, found that ninety-two percent of older people with diabetes suffer from at least one other serious health condition, and nearly 50 percent suffer from three or more other serious conditions.  The study also found that these conditions interfere with patients’ ability to keep up with their diabetes care, suggesting that doctors and health care systems need to do a better job helping patients juggle the demands of dealing with multiple health conditions.

The new findings make it more important than ever, the researchers say, for doctors to “treat the whole person” by helping diabetes patients learn how to deal with their other conditions in ways that will allow them to also control their diabetes. The study looked at the influence that a range of medical conditions had on the participants' ability to manage their diabetes, whether or not those conditions were physically linked to diabetes.

"Patients are dealing with these issues day to day, and they're affecting the way people prioritize and manage their own self-care," says first author Eve Kerr, M.D., MPH, of the VA and UMHS. "Meanwhile, we physicians talk to patients about their diabetes, but not about how their heart failure or their hypertension is affecting how they manage their diabetes. These results show that we need to be treating the whole patient, but we don't yet have systems designed to do that."

The competing demands of simultaneous chronic diseases may lead people to neglect the self-care steps that will have the biggest impact over the long run, Kerr says. For instance, if a person with diabetes also has arthritis pain, or shortness of breath from heart failure, and these aren't fully addressed, the person may refrain from physical activity. And that in turn means they'll struggle to control their blood sugar or blood pressure - which is important to prevent future issues such as stroke.

Also important, the study found, is whether patients perceive that their other conditions are related to their diabetes. For instance, many people with diabetes don't realize that their disease puts them at much higher risk of heart disease and stroke. That lack of awareness may mean that they don't put as much emphasis on their blood pressure or cholesterol, when in fact controlling those risk factors can greatly influence the health of a person with diabetes.

That's why a whole-person approach to care is so important, says Kerr, who is an associate professor of internal medicine at the U-M Medical School and associate director of the VA Health Services Research & Development's Center for Clinical Management Research.

Kerr co-directs Quality Improvement for Complex Chronic Conditions, a joint U-M/VA research program directed by John Piette, Ph.D., senior author of the new paper. Together with other U-M and VA researchers, they are studying the issues that face patients who have multiple conditions, and their caregivers. They're also devising tools to help assess and improve care for such patients.

To view a paper on the study’s findings, click here.