Abstract
BackgroundThe increased prevalence of type 1 diabetes mellitus in children and adolescents with its complications, especially microvascular ones (retinopathy, nephropathy, and neuropathy) that affect the expectancy of their lives, besides imposing restrictions on their physical, emotional, and social functioning, adversely affecting their quality of life, in turn would lead to worsening of their compliance and adherence to the treatment with subsequent hazards on metabolic control, development, and progression of adverse diabetic complications that might cause multiple organ damage and impose more disease burden and impact the quality of life of the growing young diabetics and their families.AimThe aim of the present study was to assess health-related quality of life of a group of Egyptian children and adolescents with type 1 diabetes in addition to investigate the relation of microvascular complications and other sociodemographic and clinical indicators to their quality of life.Subjects and methodsThis case-control study was executed in the Diabetes Clinic and in the outpatient clinics, Children’s Hospital, Ain Shams University, and Medical Research Centre of Excellence clinics, June 2013–June 2015, which was carried out on 60 children and adolescents with type 1 diabetes mellitus, with ages ranged between (8-18) years compared with 60 apparently healthy children matched as regards their age, sex, and socioeconomic status.ResultsNo significant differences between studied diabetic and healthy children (8–12 years) (total generic health-related quality of life score mean = (77.05 ± 14.58 vs. 79.32 ± 11.15, respectively). But there was a significant decrease for studied diabetic adolescents (13–18 years) compared to healthy peers (64.37 ± 14.54 vs. 74.74 ± 13.34, respectively). Microvascular complications impacted the health-related quality of life of type 1 diabetic children and adolescents, the most worsen effect was associated with neuropathy (p < 0.001). Statistically significant negative correlations were found between health-related quality of life domains with all metabolic control parameters, and the strongest correlation was between treatment adherence scale with HbA1c% (r = − 0.941, p ˂ 0.001).ConclusionHealth-related quality of life of the studied diabetic children and adolescents was negatively affected by the development of microvascular complications, especially diabetic neuropathy, while positively affected by achieving good metabolic control (HbA1c < 8%).
Highlights
The increased prevalence of type 1 diabetes mellitus in children and adolescents with its complications, especially microvascular ones that affect the expectancy of their lives, besides imposing restrictions on their physical, emotional, and social functioning, adversely affecting their quality of life, in turn would lead to worsening of their compliance and adherence to the treatment with subsequent hazards on metabolic control, development, and progression of adverse diabetic complications that might cause multiple organ damage and impose more disease burden and impact the quality of life of the growing young diabetics and their families
Thirty out of 60 patients had one or more microvascular complications; the most common chronic complication encountered in the studied patients was diabetic microalbuminuria being in 22 (13 patients had nephropathy alone and nine patients had nephropathy with other complications) representing 36.7% of all diabetic patients, followed by peripheral neuropathy being in 16 patients representing 26.7% of all diabetic patients and retinopathy being in five patients representing 8.3% of all diabetic patients (Fig. 1)
There was significant difference (p < 0.05) between complicated and non-complicated patients regarding age of onset of disease, disease duration, mean random blood glucose, HbA1c, and mean insulin dose, being higher in complicated patients except for age of onset of disease
Summary
The increased prevalence of type 1 diabetes mellitus in children and adolescents with its complications, especially microvascular ones (retinopathy, nephropathy, and neuropathy) that affect the expectancy of their lives, besides imposing restrictions on their physical, emotional, and social functioning, adversely affecting their quality of life, in turn would lead to worsening of their compliance and adherence to the treatment with subsequent hazards on metabolic control, development, and progression of adverse diabetic complications that might cause multiple organ damage and impose more disease burden and impact the quality of life of the growing young diabetics and their families. Numerous studies have reported an increasing incidence of type 1 diabetes in children worldwide (Patterson et al 2015; El Wakeel et al 2017; Sabry et al 2018). It has major health consequences for individuals and societies. Fear of hypoglycemia may promote compensatory behaviors in order to avoid hypoglycemia, such as decreased insulin doses, resulting in poor glycemic control, and an increased risk of serious health consequences, with further contribution to the negative impact on health and QOL (Hoey et al 2001; Nordfeldt and Ludvigsson 2005; Fidler et al 2011; Bahia et al 2017)
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