Quality of life and treatment satisfaction in Type 2 diabetes patients using multipl dose injection insulin therapy

The aim of this study is to put forward the potential positive or negative impacts of the insulin treatment on quality of life perceived by the patients, who were diagnosed as type 2 diabetes and were being treated with oral antidiabetic agents previously, and to reveal whether the patients are satisfied with this treatment or not.In our study, a total of 65 people were selected among the patients, who were previously diagnosed with type 2 diabetes and started to be treated with basal-bolus insulin therapy due to insufficient glycemic control with the oral antidiabetic treatment. The Turkish version of the WHOQOL-bref, DTSQs, EQ-5D questionnaires were applied in the first (0th Month) interview with these patients. Patients were called to interview after three months and six months after the first meeting, and in addition to the same questionnaires the DTSQc questionnaire of eight questions was also applied to measure the change in treatment satisfaction. A diabetes education was given in 0th, 3rd and 6th months by a diabetes training specialist nurse to all patients participating in the study. The survey results were analyzed by using the SPSS 16.0 with Mann-Whitney, Kruskal-Wallis and paired t-test, according to data characteristics. Quality of life and treatment satisfaction are the dependent variables of the study. And metabolic parameters, clinical parameters associated with the disease, disease control perception, perception of blood glucose monitoring and socio-demographic variables are the independent variables for the dependent variable of treatment satisfaction. For the dependent variable of quality of life, the treatment satisfaction was added to the independent variables included in the first model.The mean age of the patients was 53.88±8.62 (range 31-72), and 46.2% of them were male and 53.8% of them were female. All of the patients were treated with basal-bolus insulin therapy due to insufficient glycemic control with the oral antidiabetic agents, and therefore metabolic control of diabetes was poor in these patients. The average basal HbA1c was 10.02% ± 2.53, whereas it was identified as 8.21% ± 1.692 (p <0.001) at the end of the 6th month. Mean fasting blood glucose was 184.66 ± 62.11 mg/dl basal, and was 167.65 ± 64.84 mg/dl (p=0.154) at the 6th month, postprandial blood glucose was 250.21 ± 105.74 mg/dl basal, 194.28 ± 78.201 mg/dl (p=0.003) at the 6th month. The variables that affect diabetes treatment satisfaction (DTSQs) adversely, in both cross-sectional analysis and 0-3rd month or 0-6th month difference analysis, were the negative perceptions about blood glucose monitoring, the negative perceptions about disease control, limited exercise and complications such as polyneuropathy, retinopathy and hypertension. The DTSQc scale was found inversely correlated with the comorbid condition in the 3rd and 6th months. And for the quality of life dependent variable, increase in all diabetic complications were found correlated with the metabolic parameters such as HbA1c and postprandial blood sugar, hypoglycemia experience, longer therapy periods, poor perceptions about blood glucose monitoring and disease control perceptions, presence of a comorbid condition, the presence of another person with diabetes in households, the type of basal insulin, and the most importantly correlated with the treatment satisfaction change (DTSQc). Interestingly, the parameters for disease and blood glucose level management were more sensitive to WHOQOL dimensions, whereas the HbA1c value was sensitive to EQ-5D scores. In the multiple analyzes (logistic regression), it was concluded that physical dimension was only sensitive to diabetes treatment satisfaction, and the psychological dimension was only sensitive to perceptions about blood glucose monitoring. Treatment satisfaction is perceived as doctor-patient relationship by our patients rather than an improvement in metabolic parameters or disease parameters. In fact, despite the poor clinical parameters of the patients the treatment satisfaction was increased significantly due to the frequent doctor-patient relationships. The diabetes-specific metabolic parameters and treatment satisfaction was also found effective on quality of life, other than the known socio-demographic indicators.