Trajectories of Health-Related Quality of Life and HbA1c Values of Children and Adolescents With Diabetes Mellitus Type 1 Over 6 Months: A Longitudinal Observational Study

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. Fischer et al. Longitudinal Quality of Life of Children With T1DM 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.

Outcomes of monthly video consultations as an add‐on to regular care for children with type 1 diabetes: A 6‐month quasi‐randomized clinical trial followed by an extension phase

“…In this 6‐month intervention, no difference was found in the two adult cohorts 18 . In contrast, a German study observed lower scores in some domains of the HRQOL instrument Kids‐CAT in children and youths with HbA1c > 9% 19 . However, it is possible that our questionnaires on HRQOL did not cover specific aspects that can be influenced by monthly video consultation, such as an increased feeling of security or control through more frequent contacts with the diabetes team.…”

“…18 In contrast, a German study observed lower scores in some domains of the HRQOL instrument Kids-CAT in children and youths with HbA1c > 9%. 19 However, it is possible that our questionnaires on HRQOL did not cover specific aspects that can be influenced by monthly video consultation, such as an increased feeling of security or control through more frequent contacts with the diabetes team. Nevertheless, the treatment-specific outcomes, namely, diabetes burden and treatment satisfaction, differed FDR significantly between IG and WG in our study.…”

All together: Integrated care for youth with type 1 diabetes

“…Overall, the quantitative evaluation demonstrated that our sample of adolescents had similar characteristics in terms of gender, insulin pump use, and average A1c levels compared to US registries and European studies. 50 , 51 The subgroup of adolescents who had low WHO‐5 scores, underwent secondary screening, and received a timely assessment by a child psychiatrist allowing access to follow‐up care without the need for a referral to community mental health services. The timely assessments were facilitated by additional funding to support the TeleLink Mental health Program.…”

Trying to be like everybody else: A qualitative study revealing the importance of social contexts and illness representations among adolescents with type 1 diabetes and their parents

“…16 Psychosocially, associating positively with peers is important and seems to influence the decision-making process in selfmanagement, distress, negative moods, and negative self-image/confidence-all of which are factors that affect poor glycemic control. 11,17,18 One quantitative study revealed how the age group of emerging adults (18)(19)(20)(21)(22)(23)(24)(25) rated themselves as having the lowest Health-Related Quality of Life (HRQOL) compared to other age groups. 19 This was confirmed by Fischer et al 20 who looked at adolescents and young adults aged 7-27, showing how increasing age is a significant determinant of low rates of HRQOL and low ratings of HRQOL correlated with poorly regulated blood glucose.…”

“…11,17,18 One quantitative study revealed how the age group of emerging adults (18)(19)(20)(21)(22)(23)(24)(25) rated themselves as having the lowest Health-Related Quality of Life (HRQOL) compared to other age groups. 19 This was confirmed by Fischer et al 20 who looked at adolescents and young adults aged 7-27, showing how increasing age is a significant determinant of low rates of HRQOL and low ratings of HRQOL correlated with poorly regulated blood glucose. In contrast, a study by Laffel et al 21 showed how the quality of life among children and adolescents with diabetes aged 7-17 is the same as that among controls; however, discrepancies in HRQOL were seen in reports of diabetes-specific family conflict.…”