The longitudinal association between glycaemic control and health-related quality of life following insulin therapy optimisation in type 2 diabetes patients. A prospective observational study in secondary care

Abstract

PurposeTo test whether improvement in glycosylated haemoglobin (HbA1c) as a marker of glycaemic control, following intensifying insulin therapy, is associated with improvements in HRQoL.MethodsDutch sub-optimally controlled (HbA1c > 7%) type 2 diabetes patients (N = 447, mean age 59 ± 11) initiated insulin glargine therapy. Data were collected at baseline, 3 and 6 months, and included HbA1c and measures of HRQoL: diabetes symptom distress (Diabetes Symptom Checklist-revised; DSC-r), fear of hypoglycaemia (Hypoglycaemia Fear Survey; HFS-w) and emotional well-being (WHO-5 wellbeing index).ResultsHbA1c decreased from 8.8 ± 1.4% to 8.0 ± 1.2% and 7.7 ± 1.3% at 3 and 6 months follow-up, respectively (P < 0.001), DSC-r score improved from 17.7 ± 14.7 to 14.3 ± 13.3 and 13.6 ± 13.3 (P < 0.001). HFS-w score did not significantly change. WHO-5 score increased from 56 ± 23 to 62 ± 23 and 65 ± 22 P < 0.001). A modest, significant association was found between HbA1c and WHO-5 score (B = −1.8, 95% CI: −2.7 to −0.8) and HbA1c and DSC-r score (B = 1.0, 95% CI: 0.4 to 1.6). No such association was found for HFS-w score.ConclusionsAn association between improvement in HbA1c by means of optimising insulin therapy and improvement in HRQoL in type 2 diabetes patients has been observed. A weak, yet significant longitudinal association was found between improved HbA1c and emotional well-being and diabetes symptom distress.

Assessment of health-related quality of life among adult patients with type 2 diabetes mellitus

“…Some studies found that a better glycemic control was associated with a better HRQoL, and that complications were the most important disease-specific determinant of HRQoL [15,16], whereas other authors found no significant relationship between the HRQoL and glycemic control [17,18]. In the present study, the effect of poor blood glucose control was not seen to be associated with any of the domains, and diabetes duration had no impact on the HRQoL.…”

Quality of life in type 2 diabetes mellitus patients requiring insulin treatment in Buenos Aires, Argentina: a cross-sectional study

“…As stated by Polonsky, the relationship between HRQoL and diabetes is bidirectional; aspects of diabetes may negatively impact on HRQoL, and impaired HRQoL may also negatively influence diabetes self-management and thus health outcomes (20). Therefore, it is relevant to explore and understand those factors implicated in this relationship to Some studies found that better glycemic control was associated with better HRQoL and that complications were the most important disease-specific determinant of HRQoL (4,21,22). However, other authors found no significant relationship between HRQoL and glycemic control (23)(24)(25).…”

Toward Defining a Cutoff Score for Elevated Fear of Hypoglycemia on the Hypoglycemia Fear Survey Worry Subscale in Patients With Type 2 Diabetes

“…Patients were invited to participate in the SPIRIT and ESPRIT studies by their primary or secondary care treating physician if there was a clinical necessity to initiate long-acting insulin. Both studies are described in more detail elsewhere (14,15). The present analyses used only baseline data collected before insulin initiation or intensification.…”