title: Effects of metabolic control, patient education and initiation of insulin therapy on the quality of life of patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  The objective of this study was to evaluate the impact of initiation of insulin therapy, metabolic control and structured patient education on the diabetes-related quality of life (QoL) in insulin-treated patients with type 2 diabetes mellitus.
  
  
  METHODS
  This prospective study was conducted with 71 consecutively recruited patients with insulin-treated diabetes at the University hospital. All patients participated an inpatient diabetes treatment and teaching program (DTTP) for conventional insulin therapy (mean age 68.9 years, HbA1c 10.1+/-1.4%, diabetes duration 11.2 years (range: 0-25.5 years), body-mass-index 28.7+/-5.7 kg/m(2). Diabetes-related quality of life was assessed before and 6 months after participation in the DTTP using the standardized questionnaire of Lohr analysing the subscales: social relations, physical complaints, worries about the future, dietary restrictions, fear of hypoglycaemia, and daily struggles.
  
  
  RESULTS
  Only patients switched on insulin therapy showed significant improvement in diabetes-related quality of life 6 months after participation in the DTTP (p=0.03), fewer physical complaints (p=0.03), fewer worries about the future (p=0.02), fewer daily struggles (p=0.01) and less fear of hypoglycaemia (p<0.001), while patients, who were already on insulin therapy showed no improvements in diabetes-related quality of life. Though, residual analysis reveals that effects on patients' QoL are mainly caused by improvements in metabolic control.
  
  
  CONCLUSIONS
  Improvements in metabolic control have a significant effect on different diabetes-related quality of life domains in patients with diabetes mellitus.
  
  
  CONCLUSIONS
  Appropriate interventions resulting in better metabolic control, such as starting on insulin therapy within a structured patient education program seem to be an effective approach to improve patients' diabetes-related quality of life.
authors.affiliation: Bethanien Hospital, Department of Geriatrics at the University of Heidelberg, Heidelberg, Germany. abraun@bethanien-heidelberg.de
authors.forename: Anke
authors.initials: A
authors.lastname: Braun
authors.forename: Alexander
authors.initials: A
authors.lastname: Sämann
authors.forename: Thomas
authors.initials: T
authors.lastname: Kubiak
authors.forename: Tania
authors.initials: T
authors.lastname: Zieschang
authors.forename: Christof
authors.initials: C
authors.lastname: Kloos
authors.forename: Ulrich Alfons
authors.initials: UA
authors.lastname: Müller
authors.forename: Peter
authors.initials: P
authors.lastname: Oster
authors.forename: Gunter
authors.initials: G
authors.lastname: Wolf
authors.forename: Ralf
authors.initials: R
authors.lastname: Schiel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015190:Blood Glucose Self-Monitoring / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D005239:Fear; D005260:Female; D005858:Germany; D006801:Humans; D007003:Hypoglycemia / Q000523:psychology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin