Correlates of Quality of Life in Adults with Type 1 Diabetes Treated with Continuous Subcutaneous Insulin Injection

Continuous Subcutaneous Insulin Injection (CSII) can be prescribed to individuals with Type 1 Diabetes (T1DM) for different reasons. It is not known whether the reasons for choosing this treatment modality can have a different impact on quality of life (QoL) and treatment satisfaction (TS). Aim of this study was to compare QoL and TS among adults with T1DM according to the main indication for CSII treatment. Overall, 43 Italian diabetes clinics recruited 477 consecutive patients, aged between 18-55 years and treated with CSII. 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. QoL and TS scores were compared according to the main reason for choosing CSII: poor metabolic control (Group A, N=158), unstable disease (i.e. erratic swings of blood glucose concentration; Group B, N=197), other reasons (dawn phenomenon, desire for increased lifestyle flexibility, pregnancy; Group C, N=122). Patients in Group B were more likely to have suffered from severe hypoglycemia (26.1%) and ketoacidosis (15.7%) in the last 12 months as compared with patients in Group A (10.2% and 8.9%) and Group C (16.0% and 6.6%). At multivariate regression analysis, after adjusting for socio-economic and clinical characteristics, patients in Groups A and B had significantly lower scores for almost all the dimensions investigated by the DSQOLS as compared with patients in group C. Patients in Group B also showed significantly lower scores for all the dimensions of the SF-36 (table 1). No differences in TS were detected. [table1] In conclusion, patients with unstable diabetes, and to a lesser extent those with poor metabolic control, show particularly poor QoL, requiring patient-tailored education and psychological support.