Correlation between parameters of self-monitoring of blood glucose and the perception of health-related quality of life in patients with type 1 diabetes mellitus

ABSTRACT Objective The aim of this study was to evaluate how different parameters of short-term glycemic control would correlate with the perception of health-related quality of life (HRQoL) in patients with type 1 diabetes mellitus (T1D). Subjects and methods A total of 50 T1D patients aged 18 to 50 years were evaluated with the questionnaires Problem Areas in Diabetes (PAID) scale and Diabetes Quality of Life (DQOL) measure after 30 days of self-monitoring of blood glucose (SMBG). Glycemic control was evaluated using glycated hemoglobin (HbA1c), mean glucose levels (MGL) in the prior month's data from SMBG (Accu-Check 360o), number of hypoglycemic episodes (< 70 mg/dL and < 50 mg/dL), and glycemic variability (GV). Results PAID correlated positively with MGL (r = 0.52; p < 0.001) and HbA1c (r = 0.36; p < 0.0097), but not with GV (r = 0.17; p = 0.23) or number of hypoglycemic episodes (r = 0.15; p = 0.17 for glucose < 70 mg/dL and r = 0.02; p = 0.85 for glucose < 50 mg/dL). After multiple linear regression, only MGL remained independently related to PAID scores. DQOL scores had a positive correlation with MGL (r = 0.45; p = 0.001), but not with HbA1c (r = 0.23; p = 0.09), GV (r = 0.20; p = 0.16), or number of hypoglycemic episodes (r = 0.06 p = 0.68). Conclusion In T1D patients, MGL, but not HbA1c or number hypoglycemic episodes, was the glycemic control parameter that best correlated with short-term perception of HRQoL.

Quality of life and social life situation in islet transplanted patients: time for a change in outcome measures?

One of the overall goals in health care is to prolong life, increase patients' wellbeing and quality of life. Many of patients with severe insulin-dependent diabetes mellitus experience fear of hypoglycemia [FoH], which forces them to change their lives both physically and socially to avoid episodes of hypoglycemia. To investigate the quality of life and the social life situation, with special focus on the conse quences of FoH in islet transplanted patients. 11 patients [4 women and 7 men] were included; they have undergone islet transplantation at Uppsala University Hospital during the period 2001-2009. Short Form 36 [SF-36] and the Swedish version Hypoglycemia Fear Survey [Swe-HFS] were used to investigate quality of life, in relation to FoH. In addition, telephone interviews were conducted to investigate the patients social life situation in relation to FoH, after islet transplantation and were analyzed using a content analysis method. The mean value for quality of life was lower than that in the normal population. 3 out of 10 patients experienced FoH; one patient declined to answer the questionnaire. 3 predominant themes were revealed; one theme associated with pre-transplant, was struggle for control of social life situations and two themes associated with post-transplant, were regain power and control of social life situations and at peace with the balance between the present and the future. The patients experienced improved control over social life situation while quality of life in relation to FoH may have improved following islet transplantation

Evaluación diagnóstica psicológica sobre hipoglicemia en pacientes diabéticos con insulinoterapia / Psychological diagnosis evaluation hipoglycaemia in diabetic patients with insulinotherapy prospective study with 57 patients

La hipoglicemia es la complicación más frecuente del diabético en tratamiento insulínico. Persuadidos del deterioro progresivo de la integridad del sistema contrarregulador ante la hipoglicemia del paciente diabético, se correlacionó su comportamiento y grado de preocupación mediante el método de encuestas del Dr. Cox D., modificado, con el control de sus glicemias mensuales y hemoglobinas glicosiladas trimestrales durante 9 meses a 57 pacientes pertenecientes a la Unidad de Diabetes del Hospital Vargas de Caracas. La mayoría de nuestros pacientes demostraron estar moderadamente preocupados ante el riesgo de tener hipoglicemia con mal control; esto quizá asociado a que las complicaciones debidas a la hiperglicemia son percibidos por ellos como más deteriorantes e incapacitantes, pudiendo resolver el evento de hipoglicemia por ellos mismos mediante la ingesta de azúcares sin el control médico inmediato. Es necesario insistir en estrategias de Educación Continua al paciente diabético y a sus familiares, mediante un equipo de salud multidisciplinario, creando programas de acción social a fin de hacer eficientes los esfuerzos invertidos. De lo contrario, nuestros pacientes diabéticos llegarán a un avanzado estado de deterioro físico y psicológico, lo cual generaría mayores gastos para el Estado en su manutención, hospitalización y tratamiento

Avoidance learning under hypo and hyperglycemia in rats.

Learning behaviour under different glycaemic conditions were studied in albino rats using an avoidance box. When insulin and glucose levels were low after fasting, animals showed delay in avoidance learning. But there was no change in acquisition of learning after hypoglacaemia induced by insulin. This difference in behaviour under hypoglycaemia of almost similar severity is possibly due to difference in its rate of induction and activation of counter regulatory neuro-endocrine mechanisms. Diabetic (alloxan) rats failed to improve learning. Besides, hyperglycemia, other factors like metabolic disturbances, cytotoxic effects of alloxan may have inhibited learning in this group. Hypo or hyperglycemia disturb the function of neuronal substrates responsible for learning and memory.