Abstract
BackgroundTo assess gender differences in Quality of life (QoL) and in sociodemographic, clinical and psychological factors associated with impaired QoL in adults with long-standing type 1 diabetes mellitus (DM1).MethodsCross-sectional evaluation in a random cohort of DM1 adult patients from a tertiary care hospital. QoL was evaluated using translated and validated self-administered Diabetes QoL questionnaire (Es-DQoL), and results transformed into a 0–100 scale. Psychological assessment included a planned psychological interview and self-reported questionnaires (Beck Depression Inventory II, State-Trait Anxiety Inventory Form Y, Fear of hypoglycaemia Scale, Medical Outcomes Study Social Support Survey).ResultsA total of 312 patients (51.6% male; 38.2 ± 12.7 years; HbA1c 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.4 ± 12.0 years of DM1) were included in the analysis. Male and female subgroups showed similar sociodemographic and diabetes-related features and comparable social support. Among female patients, higher frequency of depression [31.7% (IC95% 26.2–40.8) vs. 14.9% (IC95% 10.1–20.8), p < 0.05] and anxiety [23.2% (IC95% 19.3–33.14) vs. 13.0% (IC95% 8.1–18.4), p < 0.05] and severity of depressive and anxious symptoms were also found. Compared to male patients, female patients showed lower QoL [75 (IC95% 73.6–77.5) vs. 80 (IC95% 75.7–83.1), p < 0.05] and scored significantly worse in subscale Diabetes-related worries [69 (IC95% 50.0–81.0) vs. 75 (IC95% 72.9–79.0), p < 0.05]. Fear of hypoglycemia and severity of depressive and anxious symptoms were factors independently associated to lower QoL in men and women while high frequency of glycemic excursions was a female-specific predictive one.ConclusionsAdult women with long-standing DM1 showed lower QoL probably related to higher frequency and severity of psychopathological syndromes. Depressive and anxious symptoms and, among women, exposure to glycemic excursions were identified as modifiable, QoL-related variables. Educational, technological and psychological interventions are needed in order to improve QoL in DM1 patients.
Highlights
To assess gender differences in Quality of life (QoL) and in sociodemographic, clinical and psychologi‐ cal factors associated with impaired QoL in adults with long-standing type 1 diabetes mellitus (DM1)
Castellano‐Guerrero et al Diabetol Metab Syndr (2020) 12:64 therapy is linked to a threefold increase in frequency of severe hypoglycemia, implementation of intensive treatment has increased the appearance of fear of hypoglycemia [1]
Among 152 non-included adults, 72 (47.3%) had one or more exclusion criteria, 55 (36.2%) were not interested in the study and 25 (16.4%) could not come to the appointment because of difficulties in obtaining work permit or the impossibility to travel to the hospital
Summary
To assess gender differences in Quality of life (QoL) and in sociodemographic, clinical and psychologi‐ cal factors associated with impaired QoL in adults with long-standing type 1 diabetes mellitus (DM1). Consistent data suggest that maintaining glucose levels as close as possible to the normal range prevents or delays diabetic complications [1, 2]. Living with DM1 encompasses adequate knowledge and skills, appropriate interpretation of frequent self-monitoring blood glucose levels, management of complex insulin regimen, awareness of diabetes complications and a constant self-care, a challenging process with a potential negative impact on quality of life (QoL). Fear of hypoglycemia has a relevant psychological impact and while controlling for clinical factors, could be an important diabetes-specific determinant of health-related usefulness, a generic metric of health status [4]
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