Quality of life and teatment satisfaction in patients with type 1 diabetes: a comparison between Continuous Subcutaneous Insulin Injection and Multiple Daily Injections

Results: The trials comparing Continuous Subcutaneous Insulin Injection (CSII) with Multiple Daily Injections (MDI) in adults with type 1 diabetes (T1DM) have been mainly focused on easily measurable outcomes such as glycated haemoglobin. Nevertheless, their relative benefits in terms of flexibility of lifestyle and quality of life (QoL) have been seldom investigated. Aim of this case-control study was to compare QoL and treatment satisfaction in a large sample of patients treated with either CSII or MDI. On the occasion of a routine visit, patients completed the Diabetes-Specific Quality-of-Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire, and the SF-36 Health Survey. All the scores ranged between 0 and 100, with higher scores indicating better QoL/higher satisfaction. Overall, 62 diabetes clinics enrolled 1341 patients, of whom 481 treated with CSII (cases) and 860 treated with MDI (controls). The prevalence of females was higher among cases than controls (57% vs. 46%; p<0.0001). The former also had a longer diabetes duration (18±10 years vs. 15±10 years; p<0.0001) and suffered more often from eye complications (32% vs. 22%; p<0.0001) and renal complications (11% vs. 6%; p=0.0007). No difference emerged in terms of age, school education, occupation, and HbA1c levels. At multivariate analysis, after adjusting for socio-economic and clinical characteristics, cases showed significantly higher scores than controls in the following areas of the DSQOLS: diet restrictions (β=9.96; p<0.0001), daily hassles (β=3.57; p=0.01), fears about hypoglicemia (β=3.88; p=0.006), and preference-weighted treatment satisfaction score (β=0.87; p=0.0025). Treatment with CSII was also associated with a markedly higher DTSQ score (β=11.5; p<0.0001) as compared with MDI. Finally, the DTSQ score of patients treated with CSII was significantly higher than that of patients treated with MDI including insuline glargine or NPH (p<0.0001 for both comparisons). In conclusion, patients treated with CSII have a lower perception of burdens and restrictions and a substantially higher treatment satisfaction than patients treated with MDI.