Health-related quality of life and metabolic control in pediatric and adolescent TYPE 1 diabetes mellitus patients treated with multiple dose insulin injection or continuous subcutaneous insulin infusion pump

Introduction and Purpose: Type 1 diabetes mellitus alters quality of life associated with health. Contradictive studies were published about how type 1 diabetes mellitus effects the quality of life compared to healthy population. Conventional insulin therapy gave place to intensive insulin therapy for last 20 years. Intensive insulin therapy is defined as daily multiple doses of insulin injection or subcutanous continuous insulin infusion (insulin pump therapy). Daily multiple doses of insulin injection and insulin pump therapy can effect quality of life and metabolic parameters in a variable manner. In this study we aim to contribute to type 1 diabetes mellitus treatment strategies by investigating the effects of treatment choices on quality of life and metabolic parameters of type 1 diabetes mellitus diagnosed children and adolescences that using daily multiple doses of insulin injection or subcutanous continuous insulin infusion. Materials and Method: 8 to 18 years old, type 1 DM diagnosed children that are followed in Dokuz Eylül University Childrens Hospital, Child Endocrinology Clinic and their parents are included into the study. We excluded the children who is diagnosed of any other major disease that can effect quality of life. We reached 135 type 1 DM patient and their parents between february 2020 to june 2020. We conducted questionnaire known as quality of life scale for diabetes mellitus diagnosed children (PedsQL 3.0) that is developed by Varni at all in 2003, to both parents and children. Sociodemographic data are also noted. Metabolic parameters are collected from childrens electronical records and patients files. Student T-test, independent T test, paired-sample T test and One-Way ANOVA test is used for parametrical data and for Non-parametric analysis Wilcoxon Sign, Mann- Whitney U and Kruskall-Wallis tests were used. Crosstabs, Pearson Correlation were used for non-numerical data and the results were evaluated at 95% (p <0.05) significance level. Results: Total of 135 patients and their parents were included in the study; 52.6% (n = 71) of the patients were male and 47.4% (n = 64) were female. The median age of the patients was 13 years and 54.1% (n = 73) were in the 13-18 age range. Non-diabetes disease was present in 17% (n = 23) of the patients and non-insulin drug use was detected in 9.6% (n = 13). Caregivers that is included into the study was composed of %74.8 (n=101) mothers, %23 (n=31) fathers and %2.2 other relatives. The median HbA1c was 8.3% (min 6.4-max 15.4) in the last one year. HbA1c levels of patients with ≥2 siblings were statistically significantly higher than those who did not have siblings and had 1 sibling (p <0.05). The mean HbA1c level in the last 1 year was found to be statistically significantly lower in patients aged 8-12 years compared to patients in the 13-18 age group (p = 0.001). HbA1c levels in patients whose parents monthly income was above the poverty line were found to be statistically significantly lower than those whose monthly income was below the minimum wage and those between the minimum wage and the poverty line. HbA1c levels of patients with blood glucose measurement number> 6 were found to be statistically significantly lower than patients with a daily blood glucose measurement number of ≤3 and patients with a measurement number of 4-6 (p <0.05). In all subgroups of the questionnaire and in the total questionnaire scores there was no significant difference in the quality of life of those using insulin pump therapy and those using multiple doses of insulin injections. If the quality of life of the patients was evaluated by the parents, the total questionnaire score and the scores of all subgroups of the questionnaire were found to be higher in patients using an insulin pump than the patients who applied multiple doses of insulin injection; but no statistically significant difference was found. If the number of siblings was ≥2, the quality of life questionnaire scores were statistically significantly lower (p <0.05). Conclusion: Type 1 diabetes mellitus is a chronic disease that affects the quality of life of patients and families. Although the quality of life scale in patients using insulin pumps was higher than those using multiple insulin injections, no statistically significant difference was found. Larger studies with more patients are needed to obtain stronger results.