Health-related quality of life and treatment preferences in adolescents with type 1 diabetes. The VIPKIDS study

Abstract

A multi-centre, observational, cross-sectional study was carried out to determine whether the health-related quality of life (HRQOL) of adolescents with type 1 diabetes is affected by different insulin treatment systems, and which features of HRQOL are impacted by the respective insulin treatment. The study regarded 577 adolescents, aged 10-17 years, with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) (n = 306) or multiple daily injections (MDI) (n = 271). The Insulin Delivery System Rating Questionnaire was validated in Italian and was self-completed by the subjects during a routine visit to the centres. Subjects were compared following the domains of the questionnaire. Good HRQOL was seen in subjects treated with either MDI or CSII. Significant differences were not found in the domains for general diabetes, including diabetes worries, social burden and psychological well-being. Multiple quantile regression analysis showed that CSII confers significant advantages in terms of HRQOL with improvements in treatment satisfaction, perceived clinical efficacy and reduction in treatment interference with daily activities. This favourable impact was more evident in subjects reporting lower HRQOL scores, suggesting that CSII may be especially useful for individuals perceiving a poor HRQOL. Analysis of the domains indicated that CSII was associated with a higher HRQOL than MDI. Life-course HRQOL evaluation using a standardised questionnaire can ensure better chronic disease management. This is particularly important when providing individualised care for adolescents, as they become increasingly responsible for managing their diabetes.

Psychosocial benefits of insulin pump therapy in children with diabetes type 1 and their families: The pumpkin multicenter randomized controlled trial

“…This result is in accordance with those of some recently published large cross‐sectional or registry‐based studies based on a wide age‐range . Two studies employing an age‐stratified approach showed—in contrast with our results—better DHRQOL associated with CSII compared to MDI in adolescents. These studies examined pump users as a group.…”

Recommendations for the use of sensor-augmented pumps with predictive low-glucose suspend features in children: The importance of education

“… Talk to a child (of school age)/adolescent and parents on the type of therapy (multi‐injection vs pump vs pump/sensor integrated system), identifying personalized objectives. The following are key motivational elements that should be emphasized to patients and their families: SmartGuard (PLGM) automatic protection. Effects on the patient's quality of life Effects on the family's quality of life. Effectiveness in preventing hypoglycemic episodes, which helps to control hyperglycemic episodes. Possibility of giving continuity to one's life. Possibility of reducing finger blood glucose testing. Opportunity of maintaining optimal metabolic control over time. Use, whenever possible, audio‐visual tools to support motivation in patients and their families. Highlight the advantages and disadvantages of the pump/sensor integrated system, especially pointing out that it can be a burden as well as offering many opportunities. Remind patients that the PLGM system offers some automation, the most relevant of which is hypoglycemia prevention.…”

Diabetes treatment-related quality of life is associated with levels of self-care activities in insulin injection among Japanese patients with type 2 diabetes: Diabetes Distress and Care Registry at Tenri (DDCRT 8)

“…[10]. Continuous subcutaneous insulin infusion (CSII) confers significant advantages in terms of HRQOL with improvements in treatment satisfaction, perceived clinical efficacy and reduction in treatment interference with daily activities [11]. The continuous glucose monitoring on CSII resulted in better metabolic control without imposing an additional burden on the patient [12].…”