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Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections

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Abstract Aims 

The aim of this case–control study was to compare quality of life (QoL) and treatment satisfaction in adults with Type 1 diabetes (T1DM) treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Methods 

Consecutive patients aged between 18 and 55 years, and attending diabetes clinics for a routine visit, completed the Diabetes-Specific Quality-of-Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the SF-36 Health Survey (SF-36). Case (CSII) and control subjects (MDI) were recruited in a 1 : 2 ratio. Results 

Overall, 1341 individuals were enrolled by 62 diabetes clinics; 481 were cases and 860 control subjects. Cases had a longer diabetes duration and were more likely to have eye and renal complications. Age, school education, occupation and HbA1c were similar. Of control subjects, 90% followed glargine-based MDI regimens and 10% used NPH-based MDI regimens. On multivariate analysis, after adjusting for socioeconomic and clinical characteristics, scores in the following areas of the DSQOLS were higher in cases than control subjects: diet restrictions (β = 5.96; P < 0.0001), daily hassles (β = 3.57; P = 0.01) and fears about hypoglycaemia (β = 3.88; P = 0.006). Treatment with CSII was also associated with a markedly higher DTSQ score (β = 4.13; P < 0.0001) compared with MDI. Results were similar when CSII was compared separately with glargine- or NPH-based MDI regimens. Conclusions 

This large, non-randomized, case–control study suggests quality of life gains deriving from greater lifestyle flexibility, less fear of hypoglycaemia, and higher treatment satisfaction, when CSII is compared with either glargine-based or NPH-based MDI regimens.

Diabet. Med. 25, 213–220 (2008)
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Keywords: Type 1 diabetes; continuous subcutaneous insulin infusion; multiple daily injections; quality of life; questionnaires

Document Type: Research Article

Affiliations: 1: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, (CH), 2: The Diabetes Unit, Azienda Ospedaliera S. Giovanni Addolorata, Rome, 3: Fondazione Medtronic Italia, Sesto San Giovanni (MI) , 4: Department of Medicine and Ageing, University ‘G. D’Annunzio’, Chieti and Online University ‘Leonardo da Vinci’, Torrevecchia Teatina (CH), 5: Department of Clinical and Experimental Medicine, University of Padova, Padova, 6: Diabetes Unit, AUSL Provincia di Ravenna, Ravenna, 7: Diabetes Unit, Spedali Civili di Brescia, Brescia, 8: Department of Clinical Sciences, La Sapienza University and 9: Diabetes Unit, San Camillo Hospital, Rome, Italy

Publication date: 01 February 2008

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