A cross-sectional study of the quality of life of patients living with type 1 diabetes treated with insulin glargine and neutral protamine Hagedorn insulin and the implications

Abstract

Objectives The study aim was to identify key factors associated with the health-related quality of life (HRQOL) of patients with type 1 diabetes mellitus (T1DM) treated with neutral protamine Hagedorn (NPH) insulin or human insulin analog glargine (IGLA). Methods We conducted two cross-sectional studies in Minas Gerais State, Brazil. One with 401 patients treated with IGLA, and the other with 179 T1DM patients treated with NPH. HRQOL was measured by Euroqol (EQ-5D-3L). Key findings Most participants were male (51%), aged between 18 and 40 years (47%), non-black (58%) and from the highest economic strata (A1-B2) (74%). Participants perceived their health as good/very good (51%), had one to three medical consultations in the previous year (51%), were not hospitalized in the previous year (74%), did not report angina (96%), diabetic neuropathy (90%), hearing loss (94%) or kidney disease (89%). Non-severe hypoglycaemia episodes in the last 30 days were reported by 17% of participants. Conclusions Higher HRQOL was associated with younger age (18–40 years), good/very good health self-perception, having had up to three medical consultations in the last year, not being hospitalized in the last year, having none to three comorbidities, not reporting angina, diabetic neuropathy, hearing loss or kidney disease and having had episodes of non-severe hypoglycaemia. In addition, the findings of our study demonstrated inequalities in access to treatment, which will be the subject of future research projects.

A Cross-Sectional Study of Quality of Life Among Brazilian Adults With Type 1 Diabetes Treated With Insulin Glargine: Findings and Implications

“…In the current study, most participants were young, white, from the highest social classes, and highly educated. Our findings are not surprising since in Brazil there is a great barrier to access to medicines provided in the Specialized Component of Pharmaceutical Assistance of SUS (CEAF/SUS) among the lower economic strata (25).…”

“…Barriers that contribute to insulin access for T1DM Brazilians are numerous and complex (25). Among the various barriers to access encountered, for maintain continuous insulin access, we can highlight that: patients in Minas Gerais must present at the clinic and receive a new medical prescription every 6 months (53), which includes current HbA1c levels every 6 months (30).…”

“…Brazil's HTA authority, the National Committee for Health Technology Incorporation into the Unified Health System (Conitec), in 2019 recommended the incorporation of IGla, IDet and IDeg into the Brazilian Unified Health System (SUS) (23,24). This is important as medicines indicated for incorporation by Conitec are provided free of charge to patients in Brazil (25). In addition, the different States of Brazil (Regions) can develop their own medicines lists and make accepted technologies available free to patients (12).…”

“…In addition, the different States of Brazil (Regions) can develop their own medicines lists and make accepted technologies available free to patients (12). For instance, the State of Minas Gerais listed IGla in 2005 (25). IGla is the most prescribed long-acting insulin analogue in Brazil and was incorporated in other Brazilian States (Regions) before the Conitec decision in 2019 (23).…”

Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

“…We have seen in South Africa that there is limited funding for dialysis in patients with T2DM in the public system with the authorities preferring to support preventative measures within limited funds (Makhele et al, 2019). We are also aware that children with T1DM are still at higher risk of death compared with the non-diabetic population even in high-income countries, especially those with diabetic nephropathy (Tuomilehto et al, 2020), and diabetes can also have a negative impact on patients' quality of life (Currie et al, 2006;Almeida et al, 2021;Roze et al, 2021).…”