Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications

OBJECTIVE

To measure subjective health-related quality of life (HRQoL) of patients with type 1 diabetes and describe the influence of symptoms of diabetes-related long-term complications on HRQoL.

METHODS

The 15-D health-related quality of life measure (15D) was used to measure HRQoL of a representative sample of Finnish insulin-treated patients expected to have type 1 diabetes. Background data were gathered with a separate questionnaire. A tobit (censored regression) model was constructed to estimate the effects of symptoms of complications on HRQoL and to separate these effects from those of other health problems and aging.

RESULTS

The 15D scores declined markedly with increasing age, and the prevalence of symptoms of long-term complications increased. The tobit regression model showed that these symptoms have a significant negative influence on HRQoL. The model explained over 50% of the variation in the 15D scores.

CONCLUSIONS

High prevalence of symptoms of long-term complications combined with their significant negative influence on HRQoL causes substantial losses in terms of quality of life and utility from both individual and societal perspectives. Thus, the importance of secondary prevention, i.e., prevention of complications by better metabolic control, and also the so-far theoretic possibility to prevent type 1 diabetes itself is emphasized.

Experimental and numerical predictions of the ultimate strength of a low-cost composite transtibial prosthesis

Saito et al. (Modern Plastics 1997;74:175-7) have developed a low-cost transtibial prosthesis made of fiber-reinforced plastic (FRP). The prosthesis is comprised of an aluminum pylon, a cosmetic cover, and a constant cross-section composite foot into which aluminum supports are screwed to increase load-bearing capacity. Replacing these supports with a single integrated FRP stiffener significantly reduced manufacturing cost while providing high strength, great durability, and smooth walking. The optimal location and orientation of the proposed FRP stiffener were determined by finite element (FE) analysis. When a replica of this component was tested according to ISO standard 10328, the experimental prosthesis catastrophically failed under 6,600 N of force. Maximum percent error of strain between experimental and numerical results was 18.6%, showing good correlation between the two data sets. The optimized design provides sufficient strength and reduces the cost of manufacturing and thus can be used to replace the original design.

Costs of predicting IDDM

Programmes aiming at prediction and prevention of insulin-dependent diabetes mellitus (IDDM), a multifactorial autoimmune disease, have been launched or are in the planning phase in several countries. We hypothesized that the costs of finding the correct target subjects for preventive interventions are likely to vary markedly according to the prediction strategy chosen. Average direct costs accruing in the Finnish IDDM Prediction and Prevention Project (DIPP) were analysed from the health care provider's viewpoint. The genetically targeted strategy included costs of assessing genetic IDDM susceptibility followed by measurement of marker(s) of islet autoimmunity in the susceptibility restricted population at 3 to 6-month intervals. In the pure immunological strategy markers of autoimmunity were repeatedly analysed in the entire population. The data were finally exposed to sensitivity analysis. The genetically targeted prediction strategy is cost-saving in the first year if autoimmune markers are analysed as frequently as under the DIPP project, and in all circumstances later. The 10-year direct costs per child are US$ 245 (present value $ 217, 5% discount rate) if the genetically targeted approach is used and $ 733 (present value $ 619) if the pure immunological strategy is chosen. In sensitivity analysis the 10-year costs (present value) per child of the genetically targeted strategy and of the pure immunological strategy varied from $ 152 to $ 241 and from $ 430 to $ 788, respectively. The genetically targeted IDDM prediction strategy is remarkably cost-saving as compared with the pure immunological strategy mainly because fewer subjects will need retesting during the follow-up.

Costs of insulin-dependent diabetes mellitus

Insulin-dependent diabetes mellitus (IDDM) is a prevalent chronic disease that causes marked personal and financial costs for patients, their families and society. Accurate information on costs of the disease is scarce. In this article, we review studies on disease and disease stage-connected costs at the individual and societal levels, and discuss possibilities of decreasing or preventing costs attributable to IDDM. The 3 disease stages are the initial treatment, follow-up after the initial treatment and late treatment. Total costs of IDDM in a given country depend on the incidence of the disease and the efficiency (cost effectiveness) of treatment. Besides everyday treatment costs, the acute and long term complications of the disease cause major additional costs. The lifetime financial costs of IDDM and the amount of human suffering are always substantial. The costs of the 3 clinical stages of IDDM differ markedly. The initial and late periods induce cost peaks, but the costs of follow-up after initial treatment are small. During initial treatment, costs depend mostly on the possible length of hospitalisation. During the late treatment period, costs begin to accumulate rapidly because of long term complications such as diabetic nephropathy, retinopathy, neuropathy and macrovascular disease. Intensive ambulatory care, effective patient education that results in normoglycaemia or near-normoglycaemia in patients and, if needed, shortening of hospitalisations, are the only means to restrict or decrease the costs of IDDM until primary prevention is available. Postponing complications by any length of time will always decrease human suffering and lead to marked savings in healthcare resources.

Comparison of endoscopic Nd:YAG laser therapy and oesophageal tube in palliation of oesophagogastric malignancy

The clinical results of 96 patients with upper gastrointestinal malignancy have been evaluated retrospectively. Sixty-nine patients with a mean age of 72 years (35 men and 34 women) were treated with endoscopic laser therapy, and 27 patients with a mean age of 67 years (16 men and 11 women) with insertion of an oesophageal tube. After laser therapy the bulk of the tumour was reduced in 87%, and in 55% clear signs of relieved dysphagia were seen. The insertion of an oesophageal tube was successful in 89%. In the laser group no fatal complications occurred, and the overall complication risk was 8.7%. The 1-year survival in all laser patients was 12%, and in patients with impassable tumour stenosis the survival was 6%. The mortality related to the insertion of an oesophageal tube was 11%, and complications occurred in 48% of the patients. The 1-year survival of the tube group was nil. It is concluded that endoscopic laser therapy and insertion of oesophageal tube are both effective methods in palliation of oesophagogastric malignancy, but the mortality and risk for complications were markedly lower after laser therapy.

Laser-induced hyperthermia in the treatment of liver tumors

Seven patients with malignant liver tumors were treated with Nd:YAG laser induced hyperthermia. The laserthermia was performed during laparotomy using Nd:YAG laser with contact sapphire probes with power settings of 6 W. The contact tip was placed into the middle of the tumor and the temperature in 1.5-2.0 cm from the middle of the tumor was raised and held between 41C and 45C for ten minutes. One fatal complication appeared caused by an air embolism. In the postoperative fine needle biopsies on third and fifth postoperative day the sytologic finding in the tumor was necrosis. However, in 30% of the samples there was also a suspicion of cancer cells. In the computer tomography four weeks after the treatment there were also signs of necrosis. It seems that selective destruction of malignant liver tumors is possible with contact Nd:YAG laser induced hyperthermia.

Fatal air embolism as a complication of laser-induced hyperthermia

Laser-induced hyperthermia is a new treatment modality for malignancies. When large tumors are treated with laser thermia, relatively high laser powers (4-6 W) must be used to accomplish destruction of the cancerous cells. Overheating and burning of the laser fibers and contact tips during laser thermia treatment must be prevented by using coaxial gas or fluid flow. The present report describes a case of fatal air embolism as a complication of laser thermia using coaxial gas. The authors warn all surgeons performing this procedure not to use coaxial air flow for cooling the contact tips because of the potential risk of air embolism.