title: Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes.
abstract: OBJECTIVE
  It is unclear whether the demands of good metabolic control or the consequences of poor control have a greater influence on quality of life (QOL) for adolescents with diabetes. This study aimed to assess these relations in a large international cohort of adolescents with diabetes and their families.
  
  
  METHODS
  The study involved 2,101 adolescents, aged 10-18 years, from 21 centers in 17 countries in Europe, Japan, and North America. Clinical and demographic data were collected from March through August 1998. HbA(1c) was analyzed centrally (normal range 4.4-6.3%; mean 5.4%). Adolescent QOL was assessed by a previously developed Diabetes Quality of Life (DQOL) questionnaire for adolescents, measuring the impact of diabetes, worries about diabetes, satisfaction with life, and health perception. Parents and health professionals assessed family burden using newly constructed questionnaires.
  
  
  RESULTS
  Mean HbA(1c) was 8.7% (range 4.8-17.4). Lower HbA(1c) was associated with lower impact (P < 0.0001), fewer worries (P < 0.05), greater satisfaction (P < 0.0001), and better health perception (P < 0.0001) for adolescents. Girls showed increased worries (P < 0.01), less satisfaction, and poorer health perception (P < 0.01) earlier than boys. Parent and health professional perceptions of burden decreased with age of adolescent (P < 0.0001). Patients from ethnic minorities had poorer scores for impact (P < 0.0001), worries (P < 0.05), and health perception (P < 0.01). There was no correlation between adolescent and parent or between adolescent and professional scores.
  
  
  CONCLUSIONS
  In a multiple regression model, lower HbA(1c) was significantly associated with better adolescent-rated QOL on all four subscales and with lower perceived family burden as assessed by parents and health professionals.
authors.affiliation: Department of Paediatrics, Trinity College, National Children's Hospital, Dublin, Ireland. hhoeydge@indigo.ie
authors.forename: H
authors.initials: H
authors.lastname: Hoey
authors.forename: H J
authors.initials: HJ
authors.lastname: Aanstoot
authors.forename: F
authors.initials: F
authors.lastname: Chiarelli
authors.forename: D
authors.initials: D
authors.lastname: Daneman
authors.forename: T
authors.initials: T
authors.lastname: Danne
authors.forename: H
authors.initials: H
authors.lastname: Dorchy
authors.forename: M
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: P
authors.initials: P
authors.lastname: Garandeau
authors.forename: S
authors.initials: S
authors.lastname: Greene
authors.forename: R
authors.initials: R
authors.lastname: Holl
authors.forename: P
authors.initials: P
authors.lastname: Hougaard
authors.forename: E
authors.initials: E
authors.lastname: Kaprio
authors.forename: M
authors.initials: M
authors.lastname: Kocova
authors.forename: H
authors.initials: H
authors.lastname: Lynggaard
authors.forename: P
authors.initials: P
authors.lastname: Martul
authors.forename: N
authors.initials: N
authors.lastname: Matsuura
authors.forename: H M
authors.initials: HM
authors.lastname: McGee
authors.forename: H B
authors.initials: HB
authors.lastname: Mortensen
authors.forename: K
authors.initials: K
authors.lastname: Robertson
authors.forename: E
authors.initials: E
authors.lastname: Schoenle
authors.forename: O
authors.initials: O
authors.lastname: Sovik
authors.forename: P
authors.initials: P
authors.lastname: Swift
authors.forename: R M
authors.initials: RM
authors.lastname: Tsou
authors.forename: M
authors.initials: M
authors.lastname: Vanelli
authors.forename: J
authors.initials: J
authors.lastname: Aman
mesh_terms: D000293:Adolescent; D015415:Biomarkers; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003431:Cross-Cultural Comparison; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000503:physiopathology* / Q000523:psychology*; D005060:Europe; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006304:Health Status; D006801:Humans; D007564:Japan; D008297:Male; D016011:Normal Distribution; D009656:North America; D011788:Quality of Life; D012016:Reference Values; D012044:Regression Analysis; D012737:Sex Factors; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin