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Effects of Intensive Control on Quality of Life in Type 2 Diabetes

Dec 1, 2018
 

Author: Steve Freed, R.PH., CDE


Will perceived quality of life be affected by increasing antidiabetes medication burden on the patient?

Type 2 diabetes typically leads toward a progressive loss of beta cell function. This progressive loss of function ultimately results in decreased glycemic management, which necessitates the intensification of a patient’s antidiabetes regimen via the addition of one or more medications. There has been some concern about the psychological effect that therapeutic intensification has on a patient who has diabetes. For instance, a patient may view additional therapy as a failure on their part, which may affect quality of life. Previously, the Fremantle Diabetes Study Phase I (conducted from 1993 to 1996) found that the patients who were on chronic insulin therapy typically had a lower quality of life and poorer perceived health than those who were on other regimens. In the time since phase I, many additional therapies have been released. Consequently, this study (Fremantle Diabetes Study Phase II) aims to re-evaluate the effect of diabetes regimen intensification on quality of life.

The Fremantle Diabetes Study Phase II is a prospective cohort in design. Patients were considered for inclusion as long as they were within the geographical area of Fremantle, Australia and had a verified diagnosis of diabetes. Participants were given comprehensive physical examination at baseline and every two years thereafter for up to six years. Patients were assessed via postal questionnaires, sent at 1, 3, and 5 years post baseline. During each assessment, a full medication reconciliation was conducted (either in person or by phone) and quality of life and perception of physical and mental health was assessed with the Audit of Diabetes Dependent QoL 19 (ADDQoL) and the Short Form-12 version 2(SF-12v2) respectively. Both the ADDQoL and SF-12v2 are research-validated questionnaires. After baseline data collection, patients were allocated to 1 of 3 subgroups based on initial diabetes regimen (diet only, oral glucose-lowering medications, and insulin ± oral medications). As regimens were intensified, the follow-up data was used to assess change in quality of life and perception of health. The study outlined the criteria used to select statistical analyses for specific types of data; however, it is unclear which test was used for which data set.

Of the 4,639 patients who were assessed for participation, 1,668 were recruited. Of those, 930 participants with type 2 diabetes had sufficient baseline and follow-up data to be analyzed statistically. The results of the study show a statistically significant reduction in perceived physical health at year 4 in every subgroup (p < 0.001); however, perceived mental health did not vary significantly during the study (p ≥ 0.23). Likewise, the quality of life did not significantly change in any of the study subgroups, despite medication regimen intensification (p ≥ 0.50). It was interesting to note that the scores for the insulin ± oral therapy group were lower than the oral glucose-lowering medications group (p < 0.001) and the scores for the oral glucose-lowering medications group were lower than the diet-only group (p = 0.002) throughout the study, but as stated previously, there was no statistically significant variation of perceived mental health or quality of life throughout the study.

The findings of this study suggest that as a patient’s type 2 diabetes progresses, and their medication regimens are intensified, this may correlate with a decrease in perceived physical health. However, medication regimen intensification does not seem to have any effect on a patient’s perceived mental health or quality of life. With this in mind, clinicians may alter a patient’s diabetes regimen without being concerned about decreasing a patient’s quality of life.

Practice Pearls:

  • Progression of type 2 diabetes and diabetes regimen intensification may affect a patient’s perception of their physical health.
  • Intensification of a patient’s diabetes regimen does not seem to correlate with a decrease in quality of life or perceived mental health.
  • Intensification of a patient’s diabetes regimen should not be withheld based solely on concerns of decreasing a patient’s quality of life.

Reference:

Davis, Timothy M.e., et al. “The Relationship between Intensification of Blood Glucose-Lowering Therapies, Health Status and Quality of Life in Type 2 Diabetes: The Fremantle Diabetes Study Phase II.” Diabetes Research and Clinical Practice, vol. 142, 2018, pp. 294–302., doi:10.1016/j.diabres.2018.05.047.