Quality of life and treatment satisfaction in adult with T1DM treated with CSII or MDI

Background and Aims: Many clinical trials have investigated and demonstrated the efficacy of Continuous Subcutaneous Insulin Injection (CSII) vs. Multiple Daily Injection (MDI) in individuals with Type 1 Diabetes (T1DM). However, the evidence regarding the quality of life benefits of CSII is conflicting. The aim of this case-control trial was to compare the QoL and treatment satisfaction in a large sample of individuals with T1DM treated either with CSII or MDI. Materials and Methods: Sixty-two Italian diabetes clinics enrolled 1341 consecutive patients (age 18–55 years), of whom 481 were treated with CSII (cases) and 860 with MDI (controls). During a routine visit, patients completed the Diabetes Specific Quality of Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and SF-36 Health Survey. All the scores ranged from 0 to 100, with higher scores indicating better QoL or higher satisfaction with therapy. Results: The proportion of women was higher among cases than controls (57% vs. 46%; p<0.0001). In comparison with controls, cases 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). In the control group, 90% of patients were treated with glargine-based MDI regimens. Groups did not differ with respect to age, school education, occupation and HbA1c levels. Multiple logistic regression, adjusted for socio-demographic and clinical characteristics, showed that, as compared with cases, controls had a more than threefold risk of having a DTSQ score in the lowest quartile (OR=3.3; 95%CI 2.5–5.0) and a 70% higher likelihood of having a score in the lowest quartile for the “diet restrictions” and “fear of hypoglycaemia” DSQOLS scores (OR=1.7; 95%CI 1.3–2.0 for both scores). No difference emerged between the two groups as for SF-36 scores. Results were confirmed when CSII was compared separately with glargine- or NPH-based MDI regimens. Conclusion: This is the first large scale, office based study describing how CSII affects quality of life and treatment satisfaction when compared with either glargine-based or NPH-based MDI regimens in adults with T1DM. The study documents that, despite more severe diabetes, patients treated with CSII are more satisfied of their treatment, perceive a greater lifestyle flexibility, and show less fear of hypoglycemia.