Abstract
Decision-makers have begun to recognize Health-Related Quality of Life (HRQoL) as an important and measurable outcome of healthcare interventions; and HRQoL data is increasingly being used by policy-makers to prioritize health resources. Our objective was to measure HRQoL in a group of Type 2 Diabetes Mellitus (T2DM) patients receiving insulin treatment in Buenos Aires, Argentina. We conducted a cross-sectional study of patients with T2DM over 21 years of age, treated with either Neutral Protamine Hagedorn (NPH) insulin or Insulin Glargine (IG), who had not changed their baseline schedule in the last 6 months. The recruitment was during 2006-7 in nine private diabetes specialists' offices in Buenos Aires, Argentina. A standardized diabetes-specific HRQoL questionnaire, the Audit of Diabetes Dependent Quality of Life (ADDQoL), was used. A total of 183 patients were included (93 receiving NPH and 90 receiving IG). The mean QoL score was: 0.98 (SD: 0.89) and the diabetes specific QoL was: -1.49 (SD: 0.90). T2DM had a negative impact on HRQoL with a mean Average Weighted Impact (AWI) score on QoL of -1.77 (SD: 1.58). The greatest negative impact was observed for domains: 'worries about the future', 'freedom to eat', 'living conditions', 'sex life', and 'family life'. The mean AWI score was -1.71 (SD: 1.48) in patients treated with IG and -1.85 (SD: 1.68) in patients receiving NPH, this difference was not statistically significant. The ADDQoL questionnaire is a tool that can be used in Argentina to measure the QoL of patients with diabetes when evaluating diabetes care programs. The scores of QoL in our selected population did not differ from those reported in high-income countries. We expect that the results of this study will increase healthcare providers' awareness of patients' perceived QoL and help to overcome the barriers that delay insulin treatment; mainly clinical inertia and patient resistance.
Highlights
The impact of a chronic disease has been measured in terms of either morbidity or mortality
The Audit of Diabetes Dependent Quality of Life (ADDQoL) questionnaire is a tool that can be used in Argentina to measure the QoL of patients with diabetes when evaluating diabetes care programs
When we explored the association of socio-demographic characteristics, level of glycemic control and diabetes complications with ADDQoL scores (Table 2), we only found significant differences in the analysis by gender
Summary
The impact of a chronic disease has been measured in terms of either morbidity or mortality. Many variables have been associated with HRQoL in patients with DM: age, gender, socio-economic status, obesity, type of DM, treatment, chronic complications, health insurance, quality of care and patient education [4,9,10,11,12]. Clinical inertia as well as patients’ concerns about the potential negative impact of insulin therapy on their QoL are the main barriers to the timely initiation of this treatment [14]. There is no information about QoL in patients with Type 2 Diabetes Mellitus (T2DM) receiving insulin therapy in Argentina. The primary objective of this study was to measure HRQoL in a group of T2DM receiving insulin treatment in Buenos Aires, Argentina, through a standardized diabetes-specific HRQoL questionnaire, the Audit of Diabetes Dependent Quality of Life (ADDQoL). The secondary objective was to explore variables related to HRQoL in these patients
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