1
|
Usman M, Khunti K, Davies MJ, Gillies CL. Cost-effectiveness of intensive interventions compared to standard care in individuals with type 2 diabetes: A systematic review and critical appraisal of decision-analytic models. Diabetes Res Clin Pract 2020; 161:108073. [PMID: 32061637 DOI: 10.1016/j.diabres.2020.108073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/03/2019] [Accepted: 02/10/2020] [Indexed: 01/04/2023]
Abstract
AIMS The objective of this systematic review is to identify and assess the quality of published decision-analytic models evaluating the long-term cost-effectiveness of target-driven intensive interventions for single and multifactorial risk factor control compared to standard care in people with type 2 diabetes. METHODS We searched the electronic databases MEDLINE, the National Health Service Economic Evaluation Database, Web of Science and the Cochrane Library from inception to October 31, 2019. Articles were eligible for inclusion if the studies had used a decision-analytic model evaluating both the long-term costs and benefits associated with intensive interventions for risk factor control compared to standard care in people with type 2 diabetes. Data were extracted using a standardised form, while quality was assessed using the decision-analytic model-specific Philips-criteria. RESULTS Overall, nine articles (11 models) were identified, four models evaluated intensive glycaemic control, three evaluated intensive blood pressure control, two evaluated intensive lipid control, and two evaluated intensive multifactorial interventions. Six reported using discrete-time simulations modelling approach, whereas five reported using a Markov modelling framework. The majority, seven studies, reported that the intensive interventions were dominant or cost-effective, given the assumptions and analytical perspective taken. The methodological and reporting quality of the studies was generally weak, with only four studies fulfilling more than 50% of their applicable Philips-criteria. CONCLUSIONS This is the first systematic review of decision-analytic models of target-driven intensive interventions for single and multifactorial risk factor control in individuals with type 2 diabetes. Identified shortcomings are lack of transparency in data identification and evidence synthesis as well as for the selection of the modelling approaches. Future models should aim to include greater evaluation of the quality of the data sources used and the assessment of uncertainty in the model.
Collapse
Affiliation(s)
- Muhammad Usman
- Diabetes Research Centre, University of Leicester, Leicester, UK.
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Applied Research Collaborations - East Midlands (NIHR ARC - EM), Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, UK
| | - Clare L Gillies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
2
|
Use of Diabetes Treatment Satisfaction Questionnaire in Diabetes Care: Importance of Patient-Reported Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050947. [PMID: 29747423 PMCID: PMC5981986 DOI: 10.3390/ijerph15050947] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023]
Abstract
The efficacy of diabetes treatment should not be evaluated solely by HbA1c levels as they should also focus on patient-reported outcomes (PROs), such as patient satisfaction, wellbeing and quality of life. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) has been developed to assess patient satisfaction with diabetes treatment. DTSQ has been translated into more than 100 languages and is widely used in many countries, since it is relatively easy to answer and is used for both patients with and without medical therapy. Novel therapeutic options, such as insulin analogs, incretin-based therapy and sodium-glucose cotransporter 2 (SGLT2) inhibitors, have been shown to improve patient satisfaction using DTSQ for assessments. DTSQ is not only used for comparisons between different medications or treatment strategies, but also can be used to assess the quality of diabetes care in clinical settings. This is important as an improvement in treatment satisfaction may enhance patients’ self-efficacy and adherence to therapy, leading to the achievement of long-term stable glycemic control and reduced risk of diabetic complications. In this review, we summarize the current topics in DTSQ, introducing our own experience, and discuss the role of PROs in diabetes treatment.
Collapse
|
3
|
Shi L, Hodges M, Yurgin N, Boye KS. Impact of dose frequency on compliance and health outcomes: a literature review (1966-2006). Expert Rev Pharmacoecon Outcomes Res 2012; 7:187-202. [PMID: 20528445 DOI: 10.1586/14737167.7.2.187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In order for treatments to be effective, patients must be compliant with their medication regimens. Currently, patient compliance is seen as one of the most challenging issues in treating patients with chronic diseases. Studies in which dose frequency has been changed have been reviewed across several different diseases to examine the impact of a change in dose frequency on compliance and health outcomes, as well as efficacy and tolerability. In general, reducing dose frequency may improve medication compliance and effectiveness, and reduce adverse events, while possibly reducing healthcare costs. Suggestions for future research have been presented, including a need to measure compliance with injectable formulations and a standardized definition of compliance.
Collapse
Affiliation(s)
- Lizheng Shi
- Assistant Professor, Tulane University, Department of Health Systems Management, School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA 70112, USA.
| | | | | | | |
Collapse
|
4
|
Lau AN, Tang T, Halapy H, Thorpe K, Yu CH. Initiating insulin in patients with type 2 diabetes. CMAJ 2012; 184:767-76. [PMID: 22470171 PMCID: PMC3328521 DOI: 10.1503/cmaj.110779] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Adrian N.C. Lau
- From the Department of Medicine (Lau, Tang, Yu), University of Toronto; St. Michael’s Hospital (Halapy, Yu); Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Thorpe, Yu); Dalla Lana School of Public Health (Yu), University of Toronto, Toronto, Ont
| | - Terence Tang
- From the Department of Medicine (Lau, Tang, Yu), University of Toronto; St. Michael’s Hospital (Halapy, Yu); Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Thorpe, Yu); Dalla Lana School of Public Health (Yu), University of Toronto, Toronto, Ont
| | - Henry Halapy
- From the Department of Medicine (Lau, Tang, Yu), University of Toronto; St. Michael’s Hospital (Halapy, Yu); Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Thorpe, Yu); Dalla Lana School of Public Health (Yu), University of Toronto, Toronto, Ont
| | - Kevin Thorpe
- From the Department of Medicine (Lau, Tang, Yu), University of Toronto; St. Michael’s Hospital (Halapy, Yu); Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Thorpe, Yu); Dalla Lana School of Public Health (Yu), University of Toronto, Toronto, Ont
| | - Catherine H.Y. Yu
- From the Department of Medicine (Lau, Tang, Yu), University of Toronto; St. Michael’s Hospital (Halapy, Yu); Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Thorpe, Yu); Dalla Lana School of Public Health (Yu), University of Toronto, Toronto, Ont
| |
Collapse
|
5
|
Lasserson DS, Glasziou P, Perera R, Holman RR, Farmer AJ. Optimal insulin regimens in type 2 diabetes mellitus: systematic review and meta-analyses. Diabetologia 2009; 52:1990-2000. [PMID: 19644668 DOI: 10.1007/s00125-009-1468-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 06/15/2009] [Indexed: 12/27/2022]
Abstract
AIMS/HYPOTHESIS We compared the effect of biphasic, basal or prandial insulin regimens on glucose control, clinical outcomes and adverse events in people with type 2 diabetes. METHODS We searched the Cochrane Library, MEDLINE, EMBASE and major American and European conference abstracts for randomised controlled trials up to October 2008. A systematic review and meta-analyses were performed. RESULTS Twenty-two trials that randomised 4,379 patients were included. Seven trials reported both starting insulin dose and titration schedules. Hypoglycaemia definitions and glucose targets varied. Meta-analyses were performed pooling data from insulin-naive patients. Greater HbA(1c) reductions were seen with biphasic and prandial insulin, compared with basal insulin, of 0.45% (95% CI 0.19-0.70, p = 0.0006) and 0.45% (95% CI 0.16-0.73, p = 0.002), respectively, but with lesser reductions of fasting glucose of 0.93 mmol/l (95% CI 0.21-1.65, p = 0.01) and 2.20 mmol/l (95% CI 1.70-2.70, p < 0.00001), respectively. Larger insulin doses at study end were reported in biphasic and prandial arms compared with basal arms. No studies found differences in major hypoglycaemic events, but minor hypoglycaemic events for prandial and biphasic insulin were inconsistently reported as either higher than or equivalent to basal insulin. Greater weight gain was seen with prandial compared with basal insulin (1.86 kg, 95% CI 0.80-2.92, p = 0.0006). CONCLUSIONS/INTERPRETATION Greater HbA(1c) reduction may be obtained in type 2 diabetes when insulin is initiated using biphasic or prandial insulin rather than a basal regimen, but with an unquantified risk of hypoglycaemia. Studies with longer follow-up are required to determine the clinical relevance of this finding.
Collapse
|
6
|
Speight J, Reaney MD, Barnard KD. Not all roads lead to Rome-a review of quality of life measurement in adults with diabetes. Diabet Med 2009; 26:315-27. [PMID: 19388959 DOI: 10.1111/j.1464-5491.2009.02682.x] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of self-management places great demands on the individual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately. METHODS A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008. RESULTS Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess 'QoL', only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)]. CONCLUSIONS No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully.
Collapse
Affiliation(s)
- J Speight
- AHP Research, Brunel Science Park, Brunel University, Kingston Lane, Uxbridge UB8 3PQ, UK.
| | | | | |
Collapse
|
7
|
Reaney MD, Martin C, Speight J. Understanding and Assessing the Impact of Alcoholism on Quality of Life. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2008; 1:151-63. [DOI: 10.2165/1312067-200801030-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
8
|
Bradley C, Gilbride CJB. Improving treatment satisfaction and other patient-reported outcomes in people with type 2 diabetes: the role of once-daily insulin glargine. Diabetes Obes Metab 2008; 10 Suppl 2:50-65. [PMID: 18577157 DOI: 10.1111/j.1463-1326.2008.00871.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Insulin therapy becomes essential for many people with type 2 diabetes. After starting insulin, people with diabetes that is poorly controlled with oral agents typically report improved well-being and treatment satisfaction. However, healthcare professionals and people with type 2 diabetes are often reluctant to begin insulin treatment, citing concerns such as time/resources needed to educate patients, increased risks of hypoglycaemia and fear of injections, which lead them to focus on intensifying conventional oral therapy. Insulin glargine, which offers people with diabetes a once-a-day injection regimen with low risk of hypoglycaemia, is more likely to overcome such initial barriers than other more complex insulin regimens. Once-daily insulin glargine, in combination with modern glucose-dependent oral agents that do not need to be chased with food to prevent hypoglycaemia, does not require the fixed mealtimes and set amounts of carbohydrates necessary with twice-daily injection mixes and older sulphonylureas. We know that it is such dietary restrictions that cause the most damage to quality of life (QoL). To avoid damaging QoL unnecessarily and to ensure optimal satisfaction with treatment, it is important to evaluate the effects of treatment on QoL, treatment satisfaction and other patient-reported outcomes (PROs) using questionnaires validated for this purpose, such as the widely used Diabetes Treatment Satisfaction Questionnaire and the Audit of Diabetes-Dependent Quality of Life measure. A systematic electronic literature search identified reports of studies evaluating PROs associated with insulin glargine in comparison with other treatments. The studies show that insulin glargine is usually associated with greater improvements in treatment satisfaction and other PROs compared with intensifying oral therapy or alternative insulin regimens.
Collapse
Affiliation(s)
- C Bradley
- Department of Psychology, Royal Holloway, University of London, Surrey, UK.
| | | |
Collapse
|
9
|
Kruger DF. Basal-prandial insulin: when is the right time to initiate treatment? Nurse Pract 2007; 32:24-9; quiz 29-30. [PMID: 17476163 DOI: 10.1097/01.npr.0000269469.80928.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
10
|
Abstract
Most patients with type 2 diabetes are inadequately controlled on their current therapy. Suboptimal glycemic control can have devastating consequences, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease that may ultimately lead to mortality. Most patients eventually need insulin therapy, and initiating insulin earlier in the course of type 2 diabetes may lead to optimal glycemic control and prevent or delay diabetes-related complications. Although insulin therapy is the most effective method of managing hyperglycemia, it is often delayed owing to concerns about the complexity and inconvenience of treatment regimens; fear of injections, hypoglycemia or weight gain; and the time required to learn how to effectively manage insulin therapy. The development of insulin analogs, biphasic insulin analogs, and more convenient insulin delivery systems may make insulin therapy more manageable and help more patients achieve their treatment goals.
Collapse
Affiliation(s)
- Luigi Meneghini
- Eleanor and Joseph Kosow Diabetes Treatment Center, Diabetes Research Institute, Miami, FL 33136, USA.
| |
Collapse
|
11
|
Barendse SM, Speight J, Bradley C. The Renal Treatment Satisfaction Questionnaire (RTSQ): a measure of satisfaction with treatment for chronic kidney failure. Am J Kidney Dis 2005; 45:572-9. [PMID: 15754280 DOI: 10.1053/j.ajkd.2004.11.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Quality and effectiveness of care can be enhanced through the use of condition-specific measures of satisfaction with treatment. The aim of the present study was to design and develop a measure of satisfaction with treatment for patients with chronic kidney failure (CKF) for use in routine clinical care and clinical trials. The Renal Treatment Satisfaction Questionnaire (RTSQ) was designed to be suitable for people using any of the various treatment modalities for CKF. Items measure satisfaction with aspects of treatment, including convenience, flexibility, freedom, and satisfaction to continue with present form of treatment. METHODS A 12-item RTSQ was investigated at a UK hospital-based renal unit, using data from 140 outpatients undergoing renal replacement therapy (hemodialysis, n = 35; continuous ambulatory peritoneal dialysis, n = 57; transplantation, n = 46). RESULTS An 11-item scale was developed from the original 12-item version, with a single factor accounting for 59% of the variance and item loadings greater than 0.58. Scale reliability was excellent (alpha = 0.93) in the full sample and proved robust to analysis in separate treatment subgroups. As expected, RTSQ scores differed significantly ( P < 0.0001) between the transplantation and other treatment groups. Those who had received a transplant expressed greater overall satisfaction, with specific advantages of transplantation shown by all individual items, including convenience, time, lifestyle, freedom, and satisfaction to continue current treatment. CONCLUSION The RTSQ provides a brief reliable measure of satisfaction with treatment for patients with CKF that is suitable for use in routine clinical care and clinical trials.
Collapse
Affiliation(s)
- Shalleen M Barendse
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
| | | | | |
Collapse
|
12
|
Packianathan IC, Fuller NJ, Peterson DB, Wright A, Coward WA, Finer N. Use of a reference four-component model to define the effects of insulin treatment on body composition in type 2 diabetes: the 'Darwin study'. Diabetologia 2005; 48:222-9. [PMID: 15688205 DOI: 10.1007/s00125-004-1642-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 09/15/2004] [Indexed: 12/27/2022]
Abstract
AIMS To define the effects of insulin treatment on body composition and fat distribution, and investigate the potential role of body weight (BWt) gain predictors in patients with poorly controlled type 2 diabetes. METHODS Assessments of body composition, using a four-component model, and biochemical indices were obtained in 19 patients [mean (SD): age, 60 (8.3) years; BMI, 25.3 (3.3) kg/m(2)] with poorly controlled type 2 diabetes, despite maximal oral hypoglycaemic agents, receiving insulin [40 (12.2) units/day] at baseline and after 1, 3 and 6 months. RESULTS Insulin therapy significantly reduced plasma glucose [-6.0 (4.3) mmol/l], improved [HbA(1)c [-1.9 (1.8)%], and reversed the BWt lost [3.3 (1.8) kg] before treatment. The 6-month BWt gain [+5.2 (2.7) kg] consisted of body fat [+2.9 (2.7) kg] and fat-free mass [FFM; +2.3 (1.8) kg], with the FFM increase due solely to total body water [TBW; +2.4 (1.5) l], as there were no detectable changes in total body protein or bone mineral, thereby increasing FFM hydration by 1.3%. More body fat was deposited centrally in patients receiving insulin alone than those receiving insulin with an oral hypoglycaemic agent (metformin). Daily insulin dose, HbA(1)c and hip circumference were independent predictors of BWt gain. CONCLUSIONS Insulin treatment increased fat and FFM similarly in poorly controlled type 2 diabetes patients, with the FFM gain due entirely to TBW. The possible role of metformin in reducing central fat accumulation following insulin treatment warrants further investigation into its mechanism and potential long-term benefits.
Collapse
Affiliation(s)
- I C Packianathan
- Wellcome Trust Clinical Research Facility and Department of Endocrinology and Diabetes, Addenbrookes Hospital, Hills Road, Cambridge, CB1 2QQ, UK
| | | | | | | | | | | |
Collapse
|
13
|
Hendra TJ, Taylor CD. A randomised trial of insulin on well-being and carer strain in elderly type 2 diabetic subjects. J Diabetes Complications 2004; 18:148-54. [PMID: 15145325 DOI: 10.1016/j.jdiacomp.2003.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Accepted: 11/24/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Selected tablet-treated elderly type 2 subjects with very poor glycaemic control may experience improvements in well-being after starting twice-daily insulin. In this study, the health status, mood, and treatment satisfaction of diabetic subjects with poor control on oral medication were assessed before and after being randomised to one of two insulin regimens. METHODOLOGY Fifty-seven type 2 subjects with poor glycaemic control (HBA(1c) 9.7%) were randomised to continue tablets (Group l), twice-daily isophane insulin (Group 2), or basal/bolus isophane/lispro insulin (Group 3). Health status, treatment satisfaction, and mood were measured at baseline, 1, 3, and 6 months. RESULTS Mean HBA(1c) levels were lower in Groups 1 and 3 at 6 months (P<.02 and.03, respectively) but not Group 2 (P=.2). Mean health status scores did not differ between the groups at any time point. In Group 3, significant within-subject improvements occurred in six domains of the SF-36 at 1 month, four domains at 3 months, and six domains at 6 months. There were no significant within-subject changes in health status scores in the other groups. Mean anxiety scores improved in both Groups 1 and 3 over 6 months, and mean depression scores also improved in Group 3 during the study. CONCLUSIONS Small improvements in health status and mood may be associated with basal/bolus, but not twice-daily, insulin in elderly type 2 subjects. These effects may be independent of glycaemic control.
Collapse
|
14
|
Bradley C, Speight J. Patient perceptions of diabetes and diabetes therapy: assessing quality of life. Diabetes Metab Res Rev 2002; 18 Suppl 3:S64-9. [PMID: 12324988 DOI: 10.1002/dmrr.279] [Citation(s) in RCA: 228] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Efforts to prevent complications of diabetes often overlook the impact of the condition and its treatment on current quality of life (QoL). The Diabetes Treatment Satisfaction Questionnaire (DTSQ) has proved valuable for understanding and measuring patients' treatment satisfaction in assessments of new treatments and strategies. For example, the DTSQ has demonstrated improved patient satisfaction with fast-acting insulin lispro versus standard soluble insulin and with long-acting insulin glargine versus NPH insulin. However, improvements in treatment satisfaction are often inferred to be improvements in overall QoL without recognizing the limited scope of the satisfaction measure. It is necessary to evaluate not only satisfaction with treatment per se but also the impact of diabetes and its treatment on a broad range of life domains in order to assess the impact on QoL. The Audit of Diabetes-Dependent Quality of Life (ADDQoL) measure is a diabetes-specific instrument that assesses the impact of diabetes on 18 life domains. Use of the ADDQoL with people with type 1 or type 2 diabetes has shown, on average, almost universally negative impact of diabetes on all domains. Significant differences have also been shown in the magnitude of effect between insulin-treated and non-insulin-treated patients and patients with and without complications. The negative impact of diabetes on QoL has been observed despite high levels of treatment satisfaction (as measured by the DTSQ). The greatest negative impact was observed for the domain 'Freedom to eat as I wish', indicating the strong influence of dietary restrictions on QoL. Studies to assess the outcomes of treatment approaches designed to improve dietary flexibility are under way.
Collapse
Affiliation(s)
- Clare Bradley
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | | |
Collapse
|
15
|
Abstract
Diabetes is common in the elderly and old UK citizens, affecting between 10% and 25%. There is considerable associated morbidity and mortality, with dementia being a common problem. The diabetic elder is also at risk of drug side-effects. Most of the evidence base for treatment is based on trials performed in younger diabetic subjects or older nondiabetic subjects; however, we can practice evidence-biased medicine whilst awaiting the results of ongoing trials. The older persons national service framework (NSF) may share some similarities with the diabetes NSF; it was 1 year late, and had no clear funding, amongst several other worries. Residential care, which is more likely to be required by diabetic elders, is also under-funded with major concerns about the quality of care for the diabetic resident. The little evidence that we have regarding care of the older diabetic person also suggests inadequacies. Given the likelihood that we will have to manage with present resources, managed clinical networks may be one way to cope.
Collapse
Affiliation(s)
- S Croxson
- Department of Medicine for the Elderly, Bristol Royal Infirmary, Bristol, UK.
| |
Collapse
|
16
|
Reza M, Taylor CD, Towse K, Ward JD, Hendra TJ. Insulin improves well-being for selected elderly type 2 diabetic subjects. Diabetes Res Clin Pract 2002; 55:201-7. [PMID: 11850096 DOI: 10.1016/s0168-8227(01)00327-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The effects of insulin therapy on patient well-being, treatment satisfaction and mood, and on carer strain were studied in 30 elderly Type 2 diabetic patients (age 73 +/- 7 (SD) yr) in poor glycaemic control on tablet therapy. A comparison group of ten poorly controlled patients who remained on oral agents was also studied. After 4 weeks of insulin treatment, there were significant improvements in mental health, role-emotional, role-physical (all P<0.05) and vitality (P<0.01) domains of the short form health survey (SF-36), and also in the diabetes treatment and satisfaction questionnaire (DTSQ) and geriatric depression scale (both P<0.01) compared to baseline. After 12 weeks, the improvements in mental health, social functioning and vitality (P<0.01 for all domains), and in the DTSQ were sustained. Carer strain was lower at 4 weeks. No changes in outcomes were seen in the comparison group. In selected elderly Type 2 diabetic patients, insulin treatment is associated with significant improvements in well-being, treatment satisfaction and mood, even without significant improvements in glycaemic control and without increase in carer strain. The SF-36 and DTSQ are sensitive to the benefits of the changes in the treatment for these patients.
Collapse
Affiliation(s)
- M Reza
- Diabetes Centre, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | | | | | | | | |
Collapse
|
17
|
Abstract
The physical and psychological well-being of adults with Type 1 (insulin-dependent) diabetes (n = 397) were investigated using a series of questionnaires, including the Medical Outcomes Survey SF36. Development of diabetes complications and glycaemic control (glyated haemoglobin) were also measured. Results showed that older individuals, those with complications, women, the less physically active and those on lower incomes, were more likely to experience a poorer quality of life. Those who reported at least one hypoglycaemic episode per month also had poorer quality of life. This study, whilst confirming earlier work showing an association between quality of life and diabetes complications, demonstrates that other factors may also be important. Of particular interest is the association with hypoglycaemia, which has implications for diabetes care. Given the importance of reducing blood glucose levels in order to avoid complications, this focus in patient care may overlook the subsequent impact on quality of life.
Collapse
Affiliation(s)
- C E Lloyd
- Department of Public Health and Epidemiology, University of Birmingham, UK.
| | | |
Collapse
|
18
|
Well-being and symptoms in elderly Type 2 diabetes patients with poor metabolic control: Effect of insulin treatment. ACTA ACUST UNITED AC 1998. [DOI: 10.1002/pdi.1960150306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
19
|
Whitty P, Steen N, Eccles M, McColl E, Hewison J, Meadows K, Clapp Z, Hutchinson A. A new self-completion outcome measure for diabetes: is it responsive to change? Qual Life Res 1997; 6:407-13. [PMID: 9290307 DOI: 10.1023/a:1018443628933] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Self-completion instruments assessing subjective health are increasingly being used to measure patient outcome. However, there is very little evidence as yet of existing instruments' responsiveness to change. This paper describes a study to evaluate the responsiveness to change of a self-completion instrument for the measurement of clinical outcome in patients with diabetes. A prospective follow-up study of 48 patients with non-insulin-dependent diabetes commencing insulin therapy was carried out, with assessments at baseline (i.e. pre-intervention), 6 weeks and 3 months post-intervention. The outcome measures used were the changes in scores on the self-completion instrument for symptom level, physical function, energy, depression, psychological distress and barriers to activity, HbA1c, non-fasting serum cholesterol and the body mass index (BMI). There were significant improvements in HbA1c and non-fasting serum cholesterol and worsening of the BMI, as expected. The self-completion instrument detected significant improvements in patient-reported symptoms within 6 weeks of the intervention (p < 0.01) and in energy levels (p < 0.05). There is evidence from this study of the self-completion instrument's ability to respond to change and it has potential for use in evaluative studies.
Collapse
Affiliation(s)
- P Whitty
- Gateshead and South Tyneside Health Authority, UK
| | | | | | | | | | | | | | | |
Collapse
|