title: Correlates of quality of life in adults with type 1 diabetes treated with continuous subcutaneous insulin injection.
abstract: OBJECTIVE
  Aim of this study was to identify subgroups of adults with Type 1 Diabetes Mellitus (T1DM) treated with Continuous Subcutaneous Insulin Infusion (CSII) at higher risk of poor quality of life (QoL). A sample of consecutive patients completed the Diabetes Specific Quality of Life Scale (DSQOLS), investigating the daily burden and restrictions related to diabetes. Lower DSQOLS scores indicate worse QoL perception.
  
  
  RESULTS
  The main results were obtained by using a regression-tree technique (RECursive Partitioning and AMalgamation - RECPAM) and multivariate logistic regression. Overall, 472 patients aged between 18 and 55 years were recruited by 43 Italian centers. RECPAM analysis led to the identification of 5 classes characterized by a marked difference in QoL. Male patients not reporting episodes of ketoacidosis and using CSII for >2 years had the lowest likelihood of scoring in the lower tertile of the DSQOLS summary score, and thus represented the reference category. Patients who reported > or =1 ketoacidosis episodes (OR = 5.4; 95% CI 2.4-12.1) and female patients with a duration of diabetes of <10 years (OR = 5.9; 95% CI 2.6-13.5) had the highest likelihood of reporting poor QoL, while females with longer diabetes duration (OR = 2.4; 95% CI 1.3-4.7) and males treated with CSII for < or =2 years (OR = 2.2; 95% CI 1.1-4.6) showed a two-fold risk of poor QoL. Patient age, diabetic complications and civil status were globally predictive variables associated with poor QoL.
  
  
  CONCLUSIONS
  We identified subgroups of T1DM individuals treated with CSII showing a major impairment in QoL. Specific strategies are needed to help the patient cope with this therapeutic modality, especially during the initial phase of treatment.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy.
authors.forename: M
authors.initials: M
authors.lastname: Franciosi
authors.forename: A
authors.initials: A
authors.lastname: Maione
authors.forename: B
authors.initials: B
authors.lastname: Pomili
authors.forename: R
authors.initials: R
authors.lastname: Amoretti
authors.forename: E
authors.initials: E
authors.lastname: Busetto
authors.forename: F
authors.initials: F
authors.lastname: Capani
authors.forename: D
authors.initials: D
authors.lastname: Bruttomesso
authors.forename: P
authors.initials: P
authors.lastname: Di Bartolo
authors.forename: A
authors.initials: A
authors.lastname: Girelli
authors.forename: F
authors.initials: F
authors.lastname: Leonetti
authors.forename: L
authors.initials: L
authors.lastname: Morviducci
authors.forename: P
authors.initials: P
authors.lastname: Ponzi
authors.forename: E
authors.initials: E
authors.lastname: Vitacolonna
authors.forename: A
authors.initials: A
authors.lastname: Nicolucci
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017281:Cost of Illness; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology*; D016883:Diabetic Ketoacidosis / Q000523:psychology; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012727:Sex Characteristics; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D007328:Insulin