title: Patient Perspectives on Quality of Life With Uncontrolled Type 1 Diabetes Mellitus: A Systematic Review and Qualitative Meta-synthesis.
abstract: BACKGROUND
  Patients with uncontrolled type 1 diabetes mellitus may be candidates for pancreatic islet cell transplantation. This report synthesizes qualitative research on how patients with uncontrolled type 1 diabetes perceive their quality of life.
  
  
  OBJECTIVE
  The objective of this analysis was to examine the perceptions of patients with uncontrolled type 1 diabetes on how it affects their lived experience and quality of life.
  
  
  METHODS
  This report synthesizes 31 primary qualitative studies to examine quality of life from the perspectives of adult patients with type 1 diabetes mellitus and their families or partners.
  
  
  METHODS
  We performed a qualitative meta-synthesis to integrate findings across primary research studies.
  
  
  RESULTS
  Long- and short-term negative consequences of uncontrolled type 1 diabetes affect all aspects of patients' lives: physical, emotional, practical, and social. The effect on each domain is far-reaching, and effects interact across domains. Uncontrolled blood sugar levels lead to substantial psychological distress, negative moods, cognitive difficulties, irritable or aggressive behaviour, and closely associated problems with relationships, self-image, and confidence. Emotional distress is pervasive and under-addressed by health care providers. Patients live in fear of complications from diabetes over the long term. In the shorter term, they are anxious about the personal, social, and professional consequences of hypoglycemic episodes (e.g., injury, humiliation), and may curtail normal activities such as driving or socializing because they are worried about having an episode. The quality of life for patients' family members is also negatively impacted by uncontrolled type 1 diabetes.
  
  
  CONCLUSIONS
  Uncontrolled type 1 diabetes has significant negative impacts on the quality of life of both people with the disease and their families.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario ; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario.
authors.forename: Meredith
authors.initials: M
authors.lastname: Vanstone
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ontario.
authors.forename: Alex
authors.initials: A
authors.lastname: Rewegan
authors.affiliation: Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario ; Health Policy PhD Program, McMaster University, Hamilton, Ontario.
authors.forename: Francesca
authors.initials: F
authors.lastname: Brundisini
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario ; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Dejean
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario ; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario.
authors.forename: Mita
authors.initials: M
authors.lastname: Giacomini
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000209:etiology; D036301:Qualitative Research; D011788:Quality of Life; D012648:Self Care / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology