Quality of Life and Diabetes

Diabetes is a chronic condition that affects quality of life (QoL). Improving the quality of life for people with chronic conditions was the focus of a national plan (Law No. 2004-806 of August 9, 2004).

The Entred studies conducted in 2001 and 2007 provided information on the quality of life of people with type 1 and type 2 diabetes.

Analysis of Quality of Life in Entred 2007

The sociodemographic characteristics and health status indicators associated with quality of life among adults with type 2 diabetes in mainland France were studied using data from postal questionnaires and medical reimbursement records from the 2007 Entred study in a subgroup of 2,832 people with type 2 diabetes. QOL was assessed using the MOS SF-12 questionnaire. The SF-12 scale evaluates two domains of QOL: mental (MCS score) and physical (PCS score). Scores are calculated based on eight dimensions: physical functioning and limitations, physical pain, emotional limitations, mental health, vitality, social functioning, and perception. Both scores range from 0 to 100, with 100 indicating the best quality of life. The questionnaire also asked participants about their outlook on their future with diabetes, and the attending physician’s questionnaire assessed the perceived impact of diabetes on their patient. With age, the mental score remained stable while the physical score declined sharply. At all ages, both scores were lower among women. In multivariate linear regression, advanced age, diabetes characteristics and complications, perceived insufficient income, dependence on instrumental activities of daily living, and dissatisfaction with social support for diabetes were associated with lower physical and mental scores. Furthermore, an HbA1c level above 8% was associated with a low mental score, while female gender, obesity, and hospitalization during the previous year were associated with a low physical score. The QoL of people with type 2 diabetes depends heavily on the consequences of diabetes but also on socioeconomic factors and social support. Compared to the results of the INSEE Health and Medical Care 2002-2003 survey in the general population, their scores were also lower. Improving their QoL could result from better prevention of complications, greater consideration of socioeconomic difficulties, and better alignment of goals with the individual needs expressed by patients.

The 2007 Entred study also examined functional limitations related to diabetes. The results are currently being published.

Analysis of Quality of Life in Entred 2001

Quality of life was measured in 231 people with type 1 diabetes and 3,156 people with type 2 diabetes in the Entred 2001 study using a diabetes-specific self-report questionnaire: the Diabetes Health Profile (DHP). This instrument consists of 32 items for insulin-dependent people with diabetes (DHP-1) and 18 items for the adaptation of this questionnaire to people with type 2 diabetes (DHP-18). It explores three domains: psychological distress, barriers to activities, and dietary disinhibition.

Each dimension was assigned a standardized score ranging from 0 (worst quality of life) to 100 (best quality of life). The score was calculated as the average of the items within the dimension only if at least half of the items were completed. The average quality of life score for people with type 1 diabetes was approximately 67 out of 100 in each of the three dimensions. For people with type 2 diabetes, the score was over 75 in the psychological distress (81 ± 19 points) and barriers to activities (77 ± 18 points) dimensions, and 67 in the food disinhibition dimension. People with type 1 diabetes had a lower quality of life in the dimensions of barriers to activities and psychological distress compared to people with type 2 diabetes. In contrast, food disinhibition affected men with type 2 diabetes more than those with type 1 diabetes, and affected women with type 1 diabetes as much as those with type 2 diabetes. Other differences were also observed between the two types of diabetes:

  • gender differences, with a lower quality of life among women than among men, consistent with observations made in the general population in France,

  • age-related differences, with a lower quality of life among younger individuals in terms of psychological distress and food disinhibition. The consequences of diabetes, both psychologically and in terms of dietary control, appear to be more difficult for women and younger individuals to cope with.

Among the 3,090 people with type 2 diabetes under the age of 85, quality of life was lower in the dimensions of barriers to activities and psychological distress in cases of insulin treatment (up to 10 points), the presence of microvascular complications (at least 5 points), and the occurrence during the year of events such as a severe hypoglycemic episode (at least 5 points for the barriers to activities dimension). Quality of life was lower in the “food disinhibition” dimension when the person had previously followed a prescribed diet due to diabetes (approximately 5 points), in the absence of regular physical activity (approximately 5 points), and in cases of poor adherence (up to 12 points). Among people with type 1 diabetes, changes in work-related activities due to diabetes (up to 12 points), the occurrence of at least 3 severe hypoglycemic episodes in the year (at least 5 points), and the presence of other self-reported illnesses (approximately 5 points) were associated with a lower quality of life in the dimensions of barriers to activities and psychological distress. Poor autonomy in managing one’s condition (approximately 8 points) was also linked to a lower quality of life in the dimension of lack of dietary restraint.

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