Fifteen-year follow-up of quality of life in type 1 diabetes mellitus

doi:10.4239/wjd.v5.i4.569

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World Journal of Diabetes

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Observational Study

World J Diabetes. Aug 15, 2014; 5(4): 569-576
Published online Aug 15, 2014. doi: 10.4239/wjd.v5.i4.569

Table 1 Baseline characteristics (including health-related quality of life parameters) for all patients included and for patients who did an did not completed long term follow-up, categorized per treatment modality

Clinical characteristics	All enrolled patients	Patients completed follow- up until 2002 (A)who	Patients completed follow- up until 2010 (B)who	Patients who completed follow- up until 2010 (C)did not	MDI	From MDI to CSII	CSII	P-value	P-value
	(n = 281)	(n = 201)	(n = 113)	(n = 168)	(n = 52)	(n = 33)	(n = 28)	(A vs B)	(B vs C)
Age (yr)	37.2 (28.5, 45.0)	36.7 (29.0, 43.4)	37.1 (29.4, 43.0)	37.1 (27.4, 45.8)	37.6 (31.1, 43.1)	37.8 (29.8, 43.0)	34.1 (28.5, 43.9)	0.70	0.96
Sex (male)	154 (54.8)	117 (57.4)	72 (63.7)	82 (48.8)	37 (71.2)	25 (75.8)	10 (35.7)	0.25	0.01
Diabetes duration (yr)	15.0 (9.0, 23.0)	14.1 (8.7, 21.8)	13.4 (5.5, 21.2)	17.0 (10.9, 24.0)	12.3 (4.80, 21.2)	11.0 (3.70, 20.2)	17.0 (11.9, 25.9)	0.47	0.01
BMI (kg/m²)	24.4 (22.4, 26.6)	24.5 (22.6, 26.6)	24.7 (22.5, 26.7)	24.3 (22.3, 26.6)	24.8 (22.6, 27.1)	24.1 (22.6, 25.9)	24.8 (22.4, 26.9)	0.90	0.55
Systolic BP (mmHg)	139.1 (± 18.4)	137.8 (± 17.1)	137.6 (± 17.2)	140.0 (± 19.2)	140.8 (± 20.0)	131.8 (± 17.2)	138.5 (± 13.7)	0.97	0.27
HbA_1c (%)	8.2 (± 1.8)	7.6 (± 1.0)	7.9 (± 1.8)	8.5 (± 1.7)	7.6 (± 1.8)	8.0 (± 1.7)	8.4 (± 1.8)	0.65	0.01
Total cholesterol (mmol/L)	5.0 (± 1.0)	4.9 (± 0.9)	4.8 (± 0.9)	5.1 (± 1.1)	4.9 (± 1.0)	4.5 (± 1.0)	5.1 (± 0.7)	0.74	0.04
eGFR (MDRD; mL/min per 1.73 m²)	86.8 (± 23.0)	87.8 (± 21.8)	88.8 (± 15.8)	85.4 (± 26.8)	90.4 (± 15.0)	91.1 (± 15.4)	83.3 (± 16.8)	0.67	0.27
Smoking (yes)	54 (19.2)	54 (26.5)	31 (27.4)	23 (13.6)	17 (32.7)	6 (18.2)	8 (28.6)	1.00	0.95
Nephropathy (present)	55 (19.6)	34 (16.7)	17 (15.0)	38 (22.6)	10 (19.2)	3 (9.1)	4 (14.3)	0.72	0.12
Neuropathy (present)	76 (27.0)	27 (13.2)	12 (10.6)	64 (38.1)	8 (15.4)	3 (9.1)	1 (3.6)	0.53	0.01
Retinopathy (present)	96 (34.2)	64 (31.4)	32 (28.3)	64 (38.1)	14 (26.9)	7 (21.2)	11 (39.3)	0.59	0.09
Macrovascular complications (present)	2 (0.7)	2 (1.0)	1 (0.9)	1 (0.6)	1 (1.9)	0 (0)	0 (0)	0.94	0.78
Albuminuria (present)	48 (17.1)	29 (14.2)	16 (14.2)	32 (19.0)	9 (17.3)	3 (9.1)	4 (14.3)	0.99	0.30
ACEi	17 (6.0)	16 (7.8)	8 (7.1)	9 (5.4)	4 (7.7)	2 (6.1)	2 (7.1)	0.75	0.39
HRQOL parameters
SF-36
MCS	83.5 (71.4, 89.1)	84.8 (74.6, 89.6)	85.3 (77.0, 90.6)	80.2 (65.99, 88.0)	88.1 (82.8, 92.7)	85.2 (73.4, 89.6)	78.0 (68.6, 89.1)	0.20	0.01
PCS	86.8 (75.3, 92.8)	87.8 (79.1, 92.9)	88.7 (79.5, 93.7)	83.6 (70.7, 91.2)	91.4 (86.4, 94.6)	88.3 (74.4, 93.3)	87.4 (74.3, 91.2)	0.24	0.01
EuroQol
EuroQol-5D	1.00 (0.81, 1.00)	1.00 (0.84, 1.00)	1.00 (0.84, 1.00)	0.95 (0.78, 1.00)	1.00 (0.89, 1.00)	1.00 (0.84, 1.00)	1.00 (0.84, 1.00)	0.39	0.01
EuroQol-VAS	85.0 (70.0, 91.0)	85.0 (75.0, 92.0)	85.0 (80.0, 95.0)	80.0 (70.0, 90.0)	87.5 (80.0, 95.0)	85.0 (70.0, 90.5)	84.5 (70.8, 95.0)	0.45	0.02

Data are mean (± SD), median (interquartile range) or n (%). P-values are based on unpaired student T-, Mann-Whitney U- or χ²-tests. HRQOL: Health-related quality of life; BMI: Body mass index; BP: Blood pressure; eGFR: Estimated glomerular filtration rate; MDI: Multiple daily injections; CSII: Continuous subcutaneous insulin infusion; MDRD: Modification of diet in renal disease; MCS: Mental component summary; PCS: Physical component summary; ACEi: Angiotensin-converting enzyme inhibitors.

Table 2 Observed clinical parameters and health-related quality of life at long-term follow-up

Clinical characteristics	1995			2002			2010
	All	MDI	CSII	All	MDI	CSII	All	MDI	From MDI to CSII	CSII	CSII total
	(n = 281)	(n = 209)	(n = 72)	(n = 201)	(n = 110)	(n = 91)	(n = 113)	(n = 52)	(n = 33)	(n = 28)	(n = 61)
BMI (kg/m²)	24.4 (22.4, 26.6)	24.7 (22.6, 26.9)	23.8 (22.2, 26.0)	25.5 (23.4, 28.4)	25.4 (23.2, 27.8)	25.6 (23.5, 28.7)	24.7 (22.5, 26.7)	25.6 (24.0, 30.2)	26.8(24.6, 28.8)	25.4 (22.8, 29.3)	26.6 (24.2, 29.0)
Systolic BP (mmHg)	139.1 (± 18.4)	138.9 (± 19.1)	139.5 (± 16.6)	130.5 (± 17.6)	132.5 (± 18.0)	127.8 (± 17.0)	137.6 (± 17.2)	131.9 (± 13.8)	129.4 (± 12.9)	131.1 (± 12.8)	130.2 (± 12.8)
HbA_1c (mmol/mol)	8.2 (± 1.8)	8.2 (± 1.8)	8.3 (± 1.8)	7.6 (± 1.0)	7.7 (± 1.0)	7.4 (± 1.0)	7.9 (± 1.8)	7.4 (± 1.0)	7.6 (± 0.81)	7.6 (± 0.9)	7.6 (± 0.9)
Total cholesterol (mmol/L)	5.0 (± 1.0)	5.0 (± 1.0)	5.0 (± 1.0)	4.6 (± 0.9)	4.6 (± 0.9)	4.6 (± 1.0)	4.8 (± 0.9)	4.9 (± 0.9)	4.9 (± 0.8)	4.8 (± 0.6)	6.0 (± 0.9)
eGFR (MDRD; mL/ min per 1.73 m²)	86.8 (± 23.0)	89.0 (± 24.6)	80.5 (± 16.2)	87.8 (± 21.8)	81.5 (± 24.7)	80.8 (± 15.0)	88.8 (± 15.8)	91.0 (± 21.1)	92.2 (± 21.7)	92.8 (± 18.7)	92.5 (± 20.2)
SF-36
Subscales
Physical functioning	95.0 (90.0, 100.0)	95.0 (90.0, 100.0)	95.0 (76.3, 98.8)	95.0 (90.0, 100.0)	95.0 (95.0, 100.0)	95.0 (90.0, 100.0)	95.0 (87.5, 100.0)	95.0 (85.0, 100.0)	95.0 (85.0, 100.0)	95.0 (90.0, 100.0)	95.0 (90.0, 100.0)
Social functioning	100.0 (75.0, 100.0)	100.0 (87.5, 100.0)	87.5 (62.5, 100.0)	100.0 (87.5, 100.0)	100.0 (87.5, 100.0)	100.0 (75.0, 100.0)	87.5 (75.0, 100.0)	93.8 (75.0, 100.0)	87.5 (87.5, 100.0)	87.5 (65.6, 100.0)	87.5 (75.0, 100.0)
Role limitations- physical	100.0 (75.0, 100.0)	100.0 (100.0, 100.0)	100.0 (50.0, 100.0)	100.0 (100.0, 100.0)	100.0 (100.0, 100.0)	100.0 (68.8, 100.0)	100.0 (75.0, 100.0)	100.0 (100.0, 100.0)	100.0 (75.0, 100.0)	100.0 (56.3, 100.0)	100.0 (75.0, 100.0)
Role limitations- emotional	100.0 (100.0, 100.0)	100.0 (100.0, 100.0)	100.0 (33.3, 100.0)	100.0 (100.0, 100.0)	100.0 (100.0, 100.0)	100.0 (66.7, 100.0)	100.0 (100.0, 100.0)	100.0 (100.0, 100.0)	100.0 (100.0, 100.0)	100.0 (100.0, 100.0)	100.0 (100.0, 100.0)
Mental health	80.0 (68.0, 88.0)	84.0 (72.0, 92.0)	74.0 (60.0, 84.0)	84.0 (72.0, 88.0)	84.0 (76.0, 92.0)	76.0 (68.0, 84.0)	84.0 (76.0, 90.0)	88.0 (80.0, 92.0)	84.0 (72.0, 88.0)	84.0 (73.0, 88.0)	84.0 (72.0, 88.0)
Vitality	70.0 (55.0, 80.0)	75.0 (60.0, 85.0)	60.0 (41.3, 80.0)	70.0 (60.0, 80.0)	75.0 (60.0, 85.0)	65.0 (53.8, 80.0)	70.0 (55.0, 80.0)	72.5 (55.0, 80.0)	70.0 (57.5, 80.0)	62.5 (55.0, 78.8)	65.0 (65.0, 80.0)
Bodily pain	100.0 (74.0, 100.0)	100.0 (84.0, 100.0)	84.0 (62.0, 100.0)	100.0 (84.0, 100.0)	100.0 (84.0, 100.0)	100.0 (74.0, 100.0)	100.0 (79.6, 100.0)	100.0 (79.6, 100.0)	89.8 (87.8, 100.0)	89.8 (79.6, 100.0)	89.8 (83.7, 100.0)
General Health	72.0 (57.0, 87.0)	72.0 (62.0, 87.0)	67.0 (47.0, 82.0)	72.0 (62.0, 87.0)	77.0 (62.0, 87.0)	72.0 (57.0, 87.0)	65.0 (50.0, 75.0)	65.0 (50.0, 75.0)	65.0 (55.0, 75.0)	65.0 (45.0, 75.0)	65.0 (52.5, 75.0)
Component scores
MCS	83.5 (71.4, 89.1)	84.3 (75.2, 89.9)	75.1 (52.5, 87.2)	80.9 (66.2, 87.7)	80.5 (67.3, 87.1)	80.8 (63.2, 88.1)	85.3 (77.0, 90.6)	83.0 (67.0, 88.9)	80.9 (74.4, 86.2)	78.8 (66.5, 87.5)	80.8 (6.80, 86.5)
PCS	86.8 (75.3, 92.8)	87.8 (79.3, 92.9)	79.1 (57.8, 89.1)	83.5 (70.5, 90.1)	83.5 (73.0, 91.2)	84.0 (68.8, 89.3)	88.7 (79.5, 93.7)	84.9 (75.8, 90.8)	86.3 (74.9, 90.0)	81.9 (68.2, 89.6)	82.9 (74.8, 89.9)
EuroQol
EuroQol-5D	1.00 (0.81, 1.00)	1.00 (0.82, 1.00)	0.84 (0.77, 1.00)	1.00 (0.81, 1.00)	1.00 (0.80, 1.00)	0.95 (0.81, 1.00)	1.00 (0.84, 1.00)	1.00 (0.89, 1.00)	1.00 (0.84, 1.00)	1.00 (0.84, 1.00)	1.00 (0.84, 1.00)
EuroQol-VAS	85.0 (70.0, 91.0)	85.0 (75.0, 91.0)	80.0 (70.0, 93.8)	75.0 (70.0, 85.0)	75.0 (68.8, 85.0)	80.0 (70.0, 86.0)	85.0 (80.0, 95.0)	80.0 (70.0, 90.0)	80.0 (70.0, 85.0)	75.0 (80.0, 85.0)	75.0 (70.0, 85.0)

Data are presented as the mean (SD), n (%) or median (interquartile range). BMI: Body mass index; eGFR: Estimated glomerular filtration rate; MDI: Multiple daily injections; CSII: Continuous subcutaneous insulin infusion; MDRD: Modification of diet in renal disease; MCS: Mental component summary; PCS: Physical component summary.

Table 3 Estimated changes in clinical parameters during follow-up

Clinical characteristics	1995 (A)	2002 (B)	Difference (B-A)	P-value	2010 (C)	Difference (C-A)	P-value
BMI (kg/m²)
All	24.9 (24.2, 25.5)	26.2 (25.4, 27.1)	1.4 (0.14, 2.6)	0.02	27.2 (26.3, 28.2)	2.4 (1.0, 3.8)	0.00
MDI	25.1 (24.2, 25.9)	25.9 (24.8, 27.1)	0.9 (-0.9, 2.6)	0.72	27.0 (25.5, 28.4)	1.9 (-0.1, 4.0)	0.06
CSII	24.9 (23.9, 26.0)	27.2 (25.5, 28.8)	2.3 (-0.16, 4.7)	0.08	27.4 (25.5, 29.1)	2.5 (-0.2, 5.3)	0.08
From MDI to CSII	24.6 (23.5, 25.7)	25.6 (24.1, 27.1)	-1.0 (-1.2, 3.2)	0.82	27.3 (25.6, 29.1)	2.7 (0.2, 5.2)	0.03
Systolic BP (mmHg)
All	137.0 (133.8, 140.3)	128.0 (124.7, 131.2)	-9.1 (-14.7, -3.5)	0.00	130.7 (128.1, 133.3)	-6.4 (-11.4, -1.3)	0.01
MDI	140.8 (136.1, 145.4)	131.7 (127.2, 136.3)	-9.1 (- 17.0, -1.2)	0.02	131.6 (127.8, 135.3)	-9.2 (-16.4, -2.0)	0.01
CSII	138.5 (132.2, 144.8)	125.9 (119.5, 132.3)	-12.6 (-23.6, -1.7)	0.02	131.1 (126.1, 136.1)	-7.4 (-17.2, 2.4)	0.21
From MDI to CSII	131.8 (126.0, 137.7)	126.3 (120.6, 132.1)	-5.5 (-15.5, 4.5)	0.55	129.4 (124.8, 134.0)	-2.5 (-11.5, 6.6)	1.00
HbA1c (mmol/mol)
All	8.0 (7.6, 8.3)	7.6 (7.4, 7.8)	-0.37 (-0.85, 0.10)	0.19	7.5 (7.3, 7.6)	-0.47 (-0.93, 0.00)	0.05
MDI	7.6 (7.1, 8.1)	7.6 (7.3, 7.9)	-0.02 (-0.70, -0.66)	1.00	7.4 (7.1, 7.6)	-0.25 (-0.91, 0.42)	1.00
CSII	8.3 (7.7, 9.0)	7.6 (7.2, 7.9)	-0.78 (-1.71, 0.14)	0.13	7.6 (7.2, 7.9)	-0.79 (-1.70, 0.12)	0.11
From MDI to CSII	8.0 (7.3, 8.6)	7.6 (7.3, 8.0)	-0.31 (-1.16, 0.54)	1.00	7.6 (7.3, 7.9)	-0.37 (-1.20, 0.47)	0.87
Total cholesterol (mmol/L)
All	4.8 (4.7, 5.0)	4.5 (4.3, 4.7)	-0.32 (-0.62, -0.01)	0.04	4.9 (4.7, 5.0)	0.04 (-0.25, 0.32)	1.00
MDI	4.9 (4.6, 5.2)	4.6 (4.4, 4.9)	-0.27 (-0.70, 0.15)	0.38	4.9 (3.1, 6.7)	-0.01 (-0.4, 0.4)	1.00
CSII	5.1 (4.8, 5.4)	4.7 (4.3, 5.0)	-0.42 (-1.00, 0.17)	0.26	4.8 (2.4, 7.2)	-0.31 (-0.9, 0.24)	1.00
From MDI to CSII	4.5 (4.2, 4.8)	4.2 (3.9, 4.5)	-0.26 (-0.79, 0.29)	0.77	4.9 (4.6, 5.2)	0.42 (-0.1, 0.93)	0.15
eGFR (MDRD; mL/min per 1.73 m²)
All	88.3 (85.3, 91.3)	83.3 (80.9, 85.8)	-4.9 (-9.7, -0.2)	0.37	92.0 (87.9, 96.1)	-3.7 (-2.5, -9.9)	0.44
MDI	90.4 (86.6, 94.7)	83.9 (80.4, 87.4)	-6.5 (-13.2, 0.27)	0.65	91.0 (85.3, 96.7)	0.6 (-8.0, 9.4)	1.00
CSII	83.3 (77.5, 89.2)	80.6 (75.8, 85.4)	-2.7 (-11.9, 6.5)	1.00	92.8 (84.7, 100.8)	9.4 (-2.7, 21.6)	0.19
From MDI to CSII	91.1 (85.7, 96.5)	85.5 (81.0, 89.9)	-5.7 (-14.1, 2.8)	0.32	92.2 (84.9, 99.5)	1.1 (-9.9, 12.1)	1.00

Data are the mean (95%CI). Mean differences and P-values are based on linear mixed models. BMI: Body mass index; BP: Blood pressure; MDI: Multiple daily injections; CSII: Continuous subcutaneous insulin infusion.

Table 4 Estimated changes in health-related quality of life during follow-up

HRQOL parameters	1995 (A) mean	2002 (B) mean	Mean difference (B-A)	P-value	2010 (C) mean	Mean difference (C-A)	P-value
SF-36
MCS
All	81.3 (78.9, 83.7)	78.3 (75.6, 81.0)	-3.0 (-7.4, 1.4)	0.31	77.1 (74.2, 80.0)	-4.2 (-8.7, 0.41)	0.09
MDI	86.8 (83.4, 90.3)^a	80.4 (76.5, 84.3)	-6.5 (-12.8, -0.14)	0.04	77.1 (72.9, 81.2)	-9.8 (-16.3, -3.2)	0.01
CSII	78.0 (73.4, 82.6)	77.0 (71.8, 82.3)	-1.00 (-9.5, 7.5)	1.00	76.5 (70.9, 82.1)	-1.6 (-10.4, 7.3)	1.00
From MDI to CSII	79.0 (74.8, 83.3)	77.5 (72.7, 82.3)	-1.5 (-9.3, 6.3)	1.00	77.9 (72.7, 83.1)	-1.1 (-9.2, 7.0)	1.00
PCS
All	84.1 (81.6, 86.5)	81.1 (78.4, 83.8)	-3.0 (-7.5, 1.4)	0.31	79.5 (76.5, 82.4)	-4.6 (-9.3, 0.07)	0.06
MDI	88.7 (85.1, 92.2)	84.3 (80.3, 88.2)	-4.4 (-10.9, 2.0)	0.29	80.1 (75.9, 84.3)	-8.6 (-15.3, -1.8)	0.01
CSII	81.5 (76.7, 86.2)	79.3 (74.2, 84.5)	-2.1 (-10.7, 6.5)	1.00	77.8 (72.0, 83.5)	-3.7 (-12.8, 5.4)	0.98
From MDI to CSII	82.1 (77.7, 86.5)	79.6 (74.8, 84.4)	-2.5 (-10.4, 5.4)	1.00	80.5 (75.2, 85.8)	-1.6 (-9.9, 6.8)	1.00
EuroQol
EuroQol-5D
All	0.94 (0.92, 0.95)	0.91 (0.89, 0.93)	-0.03 (-0.06, 0.01)	0.12	0.94 (0.92, 0.95)	0.00 (0.03, -0.03)	1.00
MDI	0.96 (0.93, 0.98)	0.92 (0.88, 0.95)	-0.4 (-0.9, 0.01)	0.12	0.96 (0.93, 0.98)	0.00 (0.04, -0.04)	1.00
CSII	0.93 (0.90, 0.97)	0.91 (0.87, 0.95)	0.3 (-0.9, 0.04)	0.98	0.93 (0.90, 0.97)	0.00 (0.06, -0.06)	1.00
From MDI to CSII	0.92 (0.89, 0.95)	0.90 (0.86, 0.94)	0.02 (-0.08, 0.04)	1.00	0.92 (0.89, 0.95)	0.00 (0.05, -0.05)	1.00
EuroQol-VAS
All	83.6 (81.4, 85.9)	76.9 (74.4, 79.5)	-6.7 (-10.9, 2.5)	0.01	76.3 (73.8, 78.8)	-7.3 (-11.4, -3.3)	0.01
MDI	86.4 (83.1, 89.7)	78.3 (74.6, 82.0)	-8.1 (-14.1, -2.1)	0.01	78.3 (74.8, 81.8)	-8.1 (-14.0, -2.3)	0.01
CSII	82.9 (78.5, 87.2)	76.4 (71.4, 81.3)	-6.5 (-14.5, 1.6)	0.16	73.3 (68.5, 78.1)	-9.6 (-17.5, -1.7)	0.01
From MDI to CSII	81.6 (77.6, 85.6)	76.1 (71.5, 80.6)	-5.5 (-12.9, 1.9)	0.22	77.3 (73.0, 81.6)	-4.3 (-11.5, 2.9)	0.45

Data are the mean (95%CI). HRQOL: Health-related quality of life; MDI: Multiple daily injections; CSII: Continuous subcutaneous insulin infusion; MCS: Mental component summary; PCS: Physical component summary. Mean differences and P-values are based on linear mixed models.

^aP < 0.05 at that moment in time vs the MDI and from MDI to CSII treatment groups.

Citation: van Dijk PR, Logtenberg SJ, Groenier KH, Keers JC, Bilo HJ, Kleefstra N. Fifteen-year follow-up of quality of life in type 1 diabetes mellitus. World J Diabetes 2014; 5(4): 569-576
URL: https://www.wjgnet.com/1948-9358/full/v5/i4/569.htm
DOI: https://dx.doi.org/10.4239/wjd.v5.i4.569