Quality of life in tube-fed patients with diabetes mellitus

Abstract

The outcome measure that is most commonly used to assess the effectiveness of treatments for diabetes mellitus is glycemic control. In patients with type 1 diabetes, optimal glycemic control has been shown to reduce the incidence of many diabetic complications, including retinopathy, nephropathy, and neuropathy (1). However, the measures that may be required to achieve good glycemic control with intensive insulin therapy can have adverse effects on how patients perceive their health and quality of life. Thus, it is becoming clearer that good glycemic control per se does not necessarily translate into a higher quality of life for all patients. When assessing a therapy for a patient with diabetes, quality of life should be considered as an important, and perhaps independent, objective. Most studies that have addressed the issue of quality of life in diabetic patients have examined patients with early complications of the disease. Few studies have addressed the relationship between glycemic control and quality of life in hospitalized patients or those in long-term care facilities. Such patients may have already experienced severe or long-term complications of diabetes. Thus, many of the primary medical considerations for less impaired patients may become only secondary considerations in this population. Additionally, patients with diabetes who receive nutrition support via long-term tube feeding present a different set of primary concerns to the provider of care. Assessing the quality of life of these patients is difficult because many of them are not capable of expressing their thoughts or indicating their preferences or reaction to their disease, care plan, or treatment. Nevertheless, comfort and quality of life are of paramount importance in caring for both critically and chronically ill patients. This article will provide a brief overview of the factors affecting quality of life in patients with early diabetes and in patients receiving nutrition support by tube feeding. If there is an overall conclusion, it is that a great deal more needs to be learned about defining, measuring, and improving the quality of life of patients who require this level of intervention and support.