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| |  Survey Finds Exercise, Diet Are Greatest Challenges in Diabetes Regimen INDIANAPOLIS, August 12, 1996 -- Many diabetes patients say that managing aspects of their disease is difficult, according to a recent attitudinal survey of more than 600 diabetes patients.(1) Two-thirds (65%) of all patients agree with the statement "following my doctor's recommendations for diabetes care is not easy," and 41% agree they "do not feel successful at managing their diabetes." The biggest problem areas for diabetes patients appear to be getting the recommended levels of exercise and following their diet and meal plan. When asked to rate themselves on a scale of "0" to "10," where "0" means they never follow health care provider recommendations and "10" means they strictly follow recommendations, only 21% gave themselves high ratings (a "9" or "10") for strictly adhering to exercise recommendations, and only 20% scored themselves highly for following dietary advice. The same data indicate patients more readily comply with their diabetes pills (90%) and insulin shots (83%). "The survey shows us that patients are doing a good job when it comes to taking their diabetes medications, but they struggle with aspects of their care related to lifestyle modifications," commented Dr. Alan Jacobson, psychiatrist and director of mental health services for the Joslin Diabetes Center, Boston. "This is an important finding, because diet and exercise are critical aspects of caring for diabetes." Anxiety, Stress Affect Nearly a Quarter; Insulin Users More Affected Among all patients, the emotional toll of diabetes is manifested through worries about rising medical costs (38%) and the possibility of having complications in the future (30%). A quarter of patients overall report having feelings of guilt (24%), discouragement (23%) and stress (22%). Diabetes patients who take insulin to lower their blood sugar levels (who may be either Type I or Type II) express particular concern. Fifty-two percent (52%) say they worry about hypoglycemic episodes (low blood sugar reactions which can cause dizziness, fainting or coma) at least a few times a month, compared to 21% of those who use diabetes pills, and 32% of insulin users worry about future complications vs. 26% of pill users. In the U.S., 3.1 million people with diabetes are treated with insulin. Insulin users also are more likely than pill users to limit their travel or vacation plans because of their diabetes (15% vs. 8%), or face stress or burn-out (27% vs. 15%). Type I (insulin-dependent) patients also are more likely than Type II (non-insulin-dependent) patients to say that diabetes causes them to be treated differently at work (20% vs. 7%). "Their routine is more difficult, and many have had diabetes since childhood," declared Dr. Jacobson about insulin-dependent patients. "It is, therefore, not surprising that diabetes would have a more pronounced emotional impact on these people." Noncompliance = More Worry Among all patients, the emotional toll of diabetes is greatest for those who do not take care of themselves as well as they could. Those who do not feel successful with their diabetes management are more likely to worry about complications (41% vs. 20% of those who feel successful), feel discouraged (30% vs. 14%) and to feel stress (35% vs. 16%). Compared to more successful diabetes managers, they are also more likely to feel alone (25% vs. 12%) and to feel different from other people (22% vs. 13%). "Managing diabetes is a daily battle, and it's natural to feel discouraged and occasionally fall off the 'fitness wagon,'" commented Jay Leeuwenburg, center/guard for the Indianapolis Colts and an insulin-dependent diabetes patient. "But the long-term rewards of staying in shape, in terms of the way you feel and the confidence gained, are well worth the effort." Hopeful, Forthright Attitude Overall The survey revealed that the majority of diabetes patients face their disease with a positive outlook. Nine in 10 (91%) agree they feel well-informed about how to manage their condition, and a similar number (88%) agree they generally feel good about life. Eighty-five percent (85%) agree with the statement "I'm taking better care of myself than ever before." Most diabetes patients also report they are inclined to be open and forthright about their disease. Among respondents who work or go to school, 71% report that as a rule, they will usually tell their associates or fellow students about their diabetes. Nearly all (87%) Type I patients surveyed report they are open about the disease, likely because of their need to inject insulin and their increased likelihood of having low blood sugar reactions. Approximately two-thirds of all respondents report that diabetes has had no effect on their relationship with friends or family. Another 21% report it has actually had a positive effect. "The survey shows that in general, people with diabetes are coping with their disease very well. They feel pretty optimistic, and when they occasionally slip up, it's usually in their diet or exercise routine," commented Dr. John Holcombe, senior clinical research physician for Eli Lilly and Company. "We hope that by bringing the emotional aspects of the disease into sharper focus, we will be better equipped to address treatment and compliance issues." Diabetes, the fourth leading cause of death in the U.S., affects 16 million Americans, half of whom don't know they have it. The disease costs nearly $92 billion each year in health care and related costs for treatment and lost productivity. Lilly is a global research-based pharmaceutical corporation headquartered in Indianapolis, IN, that is dedicated to creating and delivering superior health care solutions -- by combining pharmaceutical innovation, existing pharmaceutical technology, disease prevention and management and information technologies -- in order to provide customers worldwide with optimal clinical outcomes. Endocrine diseases are one of five therapeutic areas in which the company is focusing its efforts. (1) Telephone interviews were conducted among a nationally representative sample of 602 diabetes patients between May 15 and June 2, 1996. Approximately half (288) had Type I diabetes. The remaining 314 respondents had Type II diabetes. The survey was conducted by Roper Starch Worldwide for Eli Lilly and Company. The margin of error for the total survey sample is +/- four percentage points. LILLY DIABETES SURVEY FACT SHEET -- Nine in 10 (91%) diabetes patients surveyed agree they "feel well-informed" about the overall care and management of the disease, and a similar number, 88%, agree that they "generally feel good about life." Eighty-five percent (85%) agree with the statement "I'm taking better care of myself than ever before." -- Diabetes patients are apt to be forthright about their disease. Seven in 10 (71%) report they usually tell their work associates or fellow students they have diabetes, and 75% of all patients tell their friends about their disease. Type I patients are even more likely to mention their diabetes, most likely so those around them would know what to do in the event of a low blood sugar reaction. -- Fewer than two in 10 diabetes patients (16%) overall report they experience any regular feelings of isolation or alienation because of their diabetes -- A diabetes patient is 10 times more likely to say "I control the diabetes" (63%) than to admit "the diabetes controls me" (6%). Follow recommendations for medication, but falter with exercise, diet -- When rating themselves on how well they follow recommendations for their diabetes care, patients give themselves high ratings for compliance with insulin (83%) or pill (90%) therapy. Somewhat lower percentages gave themselves high marks for medical check-ups (63%), testing for glucose levels (40%) and caring for their toes and feet (58%). They are less likely to rate themselves highly on following recommendations about physical activity (21%) and the foods they eat (20%). -- Two-thirds (65%) of all patients agree with the statement "following my doctor's recommendations for diabetes care is not easy," and 41% agree they "do not feel successful at managing my diabetes." -- Feeling successful about diabetes management correlates with an increased frequency of blood testing. Overall, those who test frequently (seven or more times a week) are more apt to feel successful (67%) than are less frequent blood testers (53%). -- Those who feel successful are more strict in their compliance. For example, 73% of patients who feel successful report they follow recommendations about medical visits and check-ups, compared to 49% of those who do not feel successful. Similarly, 43% of those who feel successful follow recommendations for overall diabetes management, compared to 24% of those who do not feel successful. Type I more compliant, but worry about complications -- Even though they worry about having future complications, Type I diabetes patients are more likely than Type II patients to feel successful with their diabetes management (71% vs. 56%). This is likely due to their increased compliance with many aspects of diabetes management, particularly blood testing. -- While few diabetes patients worry about the possibility of low blood sugar reactions obsessively, 37% report a hypoglycemic episode in on their mind at least a few times a month. Among insulin users, a majority (52%) report fearing a hypoglycemic episode a least a few times a month. -- Two in 10 (20%) diabetes patients overall report having had a recent hypoglycemic episode that affected their ability to carry out their everyday household tasks. Among insulin users, 26% have had such an episode recently compared to 12 % of those on oral medications. Emotional impact of diabetes - Among all patients, the emotional toll of diabetes is manifested through worries about rising medical costs (38%) and the possibility of having complications from the disease (30%). -- For the most part, patients take diabetes in stride and report it has had no particular impact on their personal life. Many patients report that having diabetes has actually had a positive effect on their relationships with family (21%) and friends (20%). For some patients, though, diabetes has had a negative effect on their personal lives, for example the desire for sexual relations (16%). -- Insulin use sometimes interferes with the lives of diabetes patients, with 10% reporting they frequently or often decide not to do something because taking their medication would be inconvenient or embarrassing. And insulin users are somewhat more likely than pill users to say they limit their social activities (20% vs. 14%) or curtail their travel or vacation plans (15%) vs. 8%). Three in 10 (30%) insulin users say diabetes has had a negative effect on their being as physically active as they would like, compared to just 18% of pill users. -- Overall, fewer than 1 in 10 patients report feeling that their diabetes has held them back from opportunities at work. However, among Type I patients, up to 20% feel their disease has caused them to miss some opportunities. -- On the positive side, majorities of diabetes patients are able to handle their emotions quite well. When they are feeling a little depressed or "low," many will talk to a friend or relative until they feel better (54%), or burn off their feelings through exercise (53%). On the negative side, many also turn to food for solace when they are feeling down. Nearly half (48%) report they will eat the wrong foods, and 29% report they will sometimes overeat. This behavior is more common among Type II patients.
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