In adults with DM1, prevalence of depression and anxiety is higher in women. Midlife patients, in particular women, show a significantly higher prevalence of anxiety symptoms and comorbid depression and anxiety. The presence of secondary complications and sustained poor glycemic control should alert to the possibility of these mental disorders, especially in the most vulnerable age population; clinical, gender and age-related patterns could help to design more effective psychological assessment and support in adult patients with DM1.

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Background: To 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). Methods: Cross-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). Results: A total of 312 patients (51.6% male; 38.2 ± 12.7 years; HbA 1c 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. Conclusions: Adult 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.

Background: To 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). Methods: Cross-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). Results: A 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% 50-81) vs. 75 (IC95% 72.9-79.0), p<0.05]. Fear of hypoglycemia and severity of depressive and anxious symptoms and were factors independently associated to lower QoL in men and women while high frequency of glycemic excursions was a female-specific predictive one. Conclusions: Adult 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.

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25Background: To determine gender differences in Quality of life (QoL) perception and to identify 26 sociodemographic, clinical and psychological characteristics associated with impaired QoL in adults with 27 long-standing type 1 diabetes mellitus (DM1). Methods: Cross-sectional evaluation in a random cohort 28 of DM1 adult patients from a tertiary care hospital. QoL was evaluated using translated and validated 29 self-administered Diabetes QoL questionnaire (Es-DQoL), and results transformed into a 0-100 scale. 30Psychological assessment included a planned psychological interview and self-reported questionnaires 31 (Beck Depression Inventory II, State-Trait Anxiety Inventory Form Y, Fear of hypoglycaemia Scale, 32 Medical Outcomes Study Social Support Survey). Results: A total of 312 patients (51.6% male; 38.2 ± 33 12.7 years; HbA 1c 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.4 ± 12.0 years of DM1) were included in the 34 analysis. Male and female subgroups showed similar sociodemographic and diabetes-related features 35 and comparable social support. Among female patients, higher frequency of depression (31.7% 36 vs.14.9%, p<0.05) and anxiety (23.2% vs. 13.0%, p<0.05) and severity of depressive and anxious 37 symptoms were also found. Compared to male patients, female patients showed a lower perception of 38 QoL (75 [65-85] vs. 80 [69-87], p<0.05) and scored significantly worse in subscale Diabetes-related 39 worries (69 [50-81] vs. 75 [62-88], p<0.05). Fear of hypoglycemia and severity of depressive and anxious 40 symptoms, as well as the presence of macrovascular complications and high frequency of glycemic 41 excursions were predictive factors of QoL. Conclusions: Adult women with long-standing DM1 showed 42 a worse QoL perception probably related to higher frequency of psychopathological syndromes. 43 Exposure to glycemic excursions and depressive and anxious symptoms were identified as modifiable, 44 QoL-related variables. Educational, technological and psychological interventions aimed at reducing 45 glycemic variability and improving psychological status are needed in order to improve QoL in DM1 46 patients. 47 Diabetology & Metabolic Syndrome Journal Research Article 3 BACKGROUND 49 Diabetes is a well-known "bio-psychosocial" model of chronic disease. A major goal of diabetes 50 care is to prevent acute and late diabetes complications. Consistent data suggest that 51 maintaining glucose levels as close as possible to the normal range prevents or delays diabetic 52 complications [1,2]. Intensified insulin regimen through both multiple daily insulin injections 53 and continuous subcutaneous insulin infusion have been proven effective in achieving near-54 euglycemia in type 1 diabetes (DM1) [1,3]. Living with DM1 encompasses adequate knowledge 55 and skills, appropriate interpretation of frequent self-monitoring blood glucose levels, 56 management of complex insulin regimen, awareness of diabetes complications and a constant 57 self-care, a challenging process with a potential negative impact on quality of life...