title: Impact of quality of life (QoL) on glycemic control (HbA1c) among adolescents and emerging adults with long-duration type 1 diabetes: A prospective cohort-study.
abstract: OBJECTIVE
  To evaluate the impact of self-reported chronic-generic and condition-specific quality of life (QoL) on glycemic control among adolescents and emerging adults with long-duration type 1 diabetes (T1D) in a longitudinal design.
  
  
  METHODS
  The database used was a nationwide cohort study of patients with ≥10 years T1D duration at baseline in Germany. The baseline questionnaire survey was conducted in 2009-2010, the follow-up survey in 2012-2013; additional clinical data of routine care procedures were linked. QoL was assessed by the DISABKIDS chronic generic module (DCGM-12) and diabetes module (DM) with treatment and impact scales. Regression analyses were conducted for the outcome hemoglobin A1c (HbA1c) at follow up with baseline DISABKIDS scores as predictors and sociodemographic and health-related covariates.
  
  
  RESULTS
  At baseline, the included 560 patients had a mean age of 15.9 (SD 2.3) years, a diabetes duration of 13.0 (2.0) years, and an HbA1c of 67 (14.2) mmol/mol. Mean follow-up time was 3.0 (0.6) years. Univariate analyses indicated associations between baseline QoL scores and HbA1c at follow-up (β[DCGM-12] = -0.174 (SE 0.038), β[DM treatment] = -0.100 (0.022), β[DM impact] = -0.177 (0.030), p < .001). The associations remained significant after adjustment for sociodemographic and illness-related factors, but dissolved (p > .60) when additionally adjusting for baseline HbA1c. In patients with poor baseline HbA1c (>75 mmol/mol), significant associations were observed between DCGM-12 and DM impact scores and follow-up HbA1c (β[DCGM-12] = -0.144 (0.062), p = .021; β[DM impact] = -0.139 (0.048), p = .004).
  
  
  CONCLUSIONS
  QoL was inversely associated with HbA1c after 3 years in the course of T1D only in patients poorly controlled at baseline.
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, German Centre for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Stahl-Pehe
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, German Centre for Diabetes Research (DZD), Düsseldorf, Germany.|Department of Statistics in Medicine, Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Landwehr
authors.affiliation: Medical Psychology Unit, Hannover Medical School, Hannover, Germany.
authors.forename: Karin S
authors.initials: KS
authors.lastname: Lange
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, German Centre for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Bächle
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, German Centre for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Katty
authors.initials: K
authors.lastname: Castillo
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, German Centre for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Rhuphine
authors.initials: R
authors.lastname: Yossa
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, German Centre for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Lüdtke
authors.affiliation: Institute of Epidemiology and Medical Biometry, University of Ulm, and German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, German Centre for Diabetes Research (DZD), Düsseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: HbA1c; adolescence; epidemiology; quality of life; type 1 diabetes