Good Metabolic Control Is Associated With Better Quality of Life in 2, 101 Adolescents With Type 1 Diabetes

Hoey, Hilary MA, MD
Aanstoot, Henk-Jan MD, PHD
Chiarelli, Francesco MD
Daneman, Denis MD
Danne, Thomas MD
Dorchy, Harry MD, PHD
Fitzgerald, Michael MD
Garandeau, Patrick MD
Greene, Stephen MD, DC
Holl, Reinhard MD
Hougaard, Philip PHD
Kaprio, Eero MD, DR MED CHIR
Kocova, Mirjana MD
Lynggaard, Helle MSC
Martul, Pedro MD, PHD
Matsuura, Nobuo MD
McGee, Hannah M. BA, PHD
Mortensen, Henrik B. MD, DR MED SCI
Robertson, Kenneth MD
Schoenle, Eugen MD
Sovik, Oddmund MD
Swift, Peter MD
Tsou, Rosa Maria MD
Vanelli, Maurizio MD
Åman, Jan MD, PHD

From the ¹Department of Paediatrics. Trinity College, National Children's Hospital, Dublin, Ireland; ²Ijsselland Hospital, Capelle, the Netherlands; the ³Pediatric University Clinic, Chieti, Italy; the ⁴Hospital for Sick Children, University of Toronto, Toronto, Canada; ⁵Charité, Humboldt University, Berlin, Germany; ⁶University Children's Hospital. Queen Fabiola, Brussels, Belgium; the ⁷Department of Psychiatry, Trinity College, Dublin, Ireland; ⁸Institut Saint Pierre, Montpellier, France; ⁹University of Dundee, Dundee, United Kingdom; the ¹⁰University of Ulm, Ulm, Germany; ¹¹Novo Nordisk, Bagsvaerd, Denmark; ¹²Peijas Hospital, Peijas, Finland; ¹³Pediatric Clinic-Skopje, Skopje, Republic of Macedonia; ¹⁴Novo Nordisk, Bagsvaerd, Denmark; ¹⁵Endocrinologia Pediatrica Hospital De Cruces, Cruces, Spain; ¹⁶Kitasato University School of Medicine, Kitasato, Japan; the ¹⁷Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland; the ¹⁸Department of Pediatrics, Glostrup University Hospital, Glostrup, Denmark; the ¹⁹Royal Hospital for Sick Children, Glasgow, United Kingdom; ²⁰University Children's Hospital, Zurich, Switzerland; ²¹Haukeland Hospital, Bergen, Norway; ²²Leicester Royal Infirmary Childrens Hospital, Leicester, United Kingdom; ²³Hospital S. Joao, Porto, Portugal; the ²⁴Department of Paediatrics, University of Parma, Italy; ²⁵Orebro Medical Centre Hospital, Orebro, Sweden.

Address correspondence and reprint requests to Professor Hilary M.C.V. Hoey, Department of Paediatrics, Trinity College, National Children's Hospital, Tallaght, Dublin, 24, Ireland. E-mail: [email protected].

Received for publication 15 December 2000 and accepted in revised form 22 June 2001.

The parent and health professional questionnaires used in this study are available from H.H.

Abbreviations: DQOL, Diabetes Quality of Life; QOL, quality of life.

A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

Diabetes Care 24(11):p 1923-1928, November 2001.

OBJECTIVE

It is unclear whether the demands of good metabolic control or the consequences of poor control have a greater influence on quality of life (QOL) for adolescents with diabetes. This study aimed to assess these relations in a large international cohort of adolescents with diabetes and their families.

RESEARCH DESIGN AND METHODS

The study involved 2,101 adolescents, aged 10-18 years, from 21 centers in 17 countries in Europe, Japan, and North America. Clinical and demographic data were collected from March through August 1998. HbA_1c was analyzed centrally (normal range 4.4-6.3%; mean 5.4%). Adolescent QOL was assessed by a previously developed Diabetes Quality of Life (DQOL) questionnaire for adolescents, measuring the impact of diabetes, worries about diabetes, satisfaction with life, and health perception. Parents and health professionals assessed family burden using newly constructed questionnaires.

RESULTS

Mean HbA_1c was 8.7% (range 4.8-17.4). Lower HbA_1c was associated with lower impact (P < 0.0001), fewer worries (P < 0.05), greater satisfaction (P < 0.0001), and better health perception (P < 0.0001) for adolescents. Girls showed increased worries (P < 0.01), less satisfaction, and poorer health perception (P < 0.01) earlier than boys. Parent and health professional perceptions of burden decreased with age of adolescent (P < 0.0001). Patients from ethnic minorities had poorer scores for impact (P < 0.0001), worries (P < 0.05), and health perception (P < 0.01). There was no correlation between adolescent and parent or between adolescent and professional scores.

CONCLUSIONS

In a multiple regression model, lower HbA_1c was significantly associated with better adolescent-rated QOL on all four subscales and with lower perceived family burden as assessed by parents and health professionals.