Abstract
Introduction: To achieve optimized blood glucose concentrations (assessed by HbA1c) and high health-related quality of life (HRQL), children and adolescents with diabetes mellitus type 1 (T1DM) must follow strict disease management strategies. This study aims to investigate HRQL of children and adolescents with T1DM and its association with HbA1c values over the course of 6 months.Methods: Patients aged 7–17 years (n = 203) with T1DM provided HRQL data on a monthly basis. HRQL was measured using the Kids-CAT, a computer-adaptive test (CAT) comprising five generic HRQL domains. HbA1c concentrations were assessed at baseline, at 3 and 6 months. We explored the trajectory of HRQL at the domain level using linear mixed effects models. Further, we investigated the association between HRQL and HbA1c concentrations over time using path analysis models.Results: Children and adolescents with T1DM reported high scores across all HRQL domains over time. However, those with an HbA1c concentrations of >9.0% reported significantly lower scores in physical well-being and parent relations compared with those with an HbA1c concentration of <7.5%. Path analysis models revealed a minimal temporal relationship between HbA1c and HRQL, with a small negative impact of HbA1c on physical well-being, psychological well-being and parent relations.Conclusion: Although observed HRQL of young patients with T1DM was comparable to age-related German-speaking reference population over the course of 6 months, those with an HbA1c concentration >9.0% reported lower scores in selected HRQL domains. Thus, special attention should be drawn to HRQL of children and adolescents with higher HbA1c concentrations. The minimal relationship between HbA1c and HRQL indicates that the two therapy goals, i.e., achievement and maintenance of glycemic targets and high HRQL, should be considered and evaluated independently in clinical routine.Trial Registration: DRKS00006326 (German Clinical Trial Register), date of registration: August 1st, 2014.
Highlights
To achieve optimized blood glucose concentrations and high health-related quality of life (HRQL), children and adolescents with diabetes mellitus type 1 (T1DM) must follow strict disease management strategies
218 consented for study participation, 13 participants where lost after consensus and two participants were excluded from the analyses due to other type of diabetes mellitus
Children and adolescents with Diabetes mellitus type 1 (T1DM) reported high scores in all five Kids-computer-adaptive test (CAT) domains over the course of 6 months referring to good healthrelated quality of life (HRQL)
Summary
To achieve optimized blood glucose concentrations (assessed by HbA1c) and high health-related quality of life (HRQL), children and adolescents with diabetes mellitus type 1 (T1DM) must follow strict disease management strategies. The main T1DM treatment aim is to achieve or maintain glycemic targets to avoid acute and long-term complications [3, 4]. An overarching treatment goal in diabetes care is achieving and maintaining high quality of life, and in particular healthrelated quality of life (HRQL), of young patients [4, 5]. In terms of glycemic target, the American Diabetes Association recommends age-independent HbA1c concentrations of
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