Good Metabolic Control Is Associated With Better Quality of Life in 2,101 Adolescents With Type 1 Diabetes

Abstract

OBJECTIVE -It is unclear whether the demands of good metabolic control or the consequences of poor control have a greater influence on quality of life (QOL) for adolescents with diabetes. This study aimed to assess these relations in a large international cohort of adolescents with diabetes and their families.RESEARCH DESIGN AND METHODS -The study involved 2,101 adolescents, aged 10 -18 years, from 21 centers in 17 countries in Europe, Japan, and North America. Clinical and demographic data were collected from March through August 1998. HbA 1c was analyzed centrally (normal range 4.4 -6.3%; mean 5.4%). Adolescent QOL was assessed by a previously developed Diabetes Quality of Life (DQOL) questionnaire for adolescents, measuring the impact of diabetes, worries about diabetes, satisfaction with life, and health perception. Parents and health professionals assessed family burden using newly constructed questionnaires.RESULTS -Mean HbA 1c was 8.7% (range 4.8 -17.4). Lower HbA 1c was associated with lower impact (P Ͻ 0.0001), fewer worries (P Ͻ 0.05), greater satisfaction (P Ͻ 0.0001), and better health perception (P Ͻ 0.0001) for adolescents. Girls showed increased worries (P Ͻ 0.01), less satisfaction, and poorer health perception (P Ͻ 0.01) earlier than boys. Parent and health professional perceptions of burden decreased with age of adolescent (P Ͻ 0.0001).Patients from ethnic minorities had poorer scores for impact (P Ͻ 0.0001), worries (P Ͻ 0.05), and health perception (P Ͻ 0.01). There was no correlation between adolescent and parent or between adolescent and professional scores.CONCLUSIONS -In a multiple regression model, lower HbA 1c was significantly associated with better adolescent-rated QOL on all four subscales and with lower perceived family burden as assessed by parents and health professionals.

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

“…Ethnicity had a greater impact than SES on HbA 1c , and moderate to severe hypoglycaemia was more prevalent in minority ethnic groups and was not associated with SES. These findings are consistent with previous reports that children from ethnic minorities have higher HbA 1c levels in both the USA [2,13,30] and Europe [15,16]. However these differences have often been ascribed to differences in SES [2,18].…”

“…Although data in childhood are limited, poor metabolic control tracks through adolescence and, in turn, HbA 1c in adolescence is strongly correlated with later adult diabetes-related outcome [10][11][12]. Cross-sectional studies typically show that children of ethnic minorities have higher HbA 1c levels [13][14][15][16]. However, it remains unclear whether this poorer metabolic control is independent of SES, and many of the studies examined selected cohorts that may not be representative of the general population [2,[17][18][19].…”

Lessons Learnt from Influences of the Marmara Earthquake on Glycemic Control and Quality of Life in People with Type 1 Diabetes

“…The DQOL is a disease-specific measure designed specifically for use in DCCT but with applicability to a wider range of people with type 1 diabetes [32]. The relation between QOL and metabolic control is controversial [13,[41][42][43][44]. Some studies reported an association between QOL and metabolic control [41,42], whereas others found no association [13,43,44].…”

Disordered Eating and Body Esteem Among Individuals with Glycogen Storage Disease

“…A study of healthy children (Bernier et al 2010) also demonstrated similar correlations between BMI percentile and overall body esteem (r ¼ À0.36 to À0.45, p < 0.01); however, those children demonstrated a negative correlation between BMI percentile and scores on the ChEAT (r ¼ À0.22 to À28, p < 0.01). When comparing to patients with chronic metabolic disease, previous research involving patients with Type I diabetes has noted that body dissatisfaction is associated with poor glycemic control, whereas good metabolic control is linked to better quality of life (Meltzer et al 2001;Hoey et al 2001). Poor metabolic control in GSD leads to greater complications and comorbid factors including hypoglycemic episodes, hepatomegaly, hyperlipidemia, hyperlactatemia, nephropathy, and hepatic adeno-mas, which may negatively impact quality of life.…”