Good Metabolic Control Is Associated With Better Quality of Life in 2,101 Adolescents With Type 1 Diabetes
- Hilary Hoey, MA, MD1,
- Henk-Jan Aanstoot, MD, PHD2,
- Francesco Chiarelli, MD3,
- Denis Daneman, MD4,
- Thomas Danne, MD5,
- Harry Dorchy, MD, PHD6,
- Michael Fitzgerald, MD7,
- Patrick Garandeau, MD8,
- Stephen Greene, MD, DC9,
- Reinhard Holl, MD10,
- Philip Hougaard, PHD11,
- Eero Kaprio, MD, DR MED CHIR12,
- Mirjana Kocova, MD13,
- Helle Lynggaard, MSC14,
- Pedro Martul, MD, PHD15,
- Nobuo Matsuura, MD16,
- Hannah M. McGee, BA, PHD17,
- Henrik B. Mortensen, MD, DR MED SCI18,
- Kenneth Robertson, MD19,
- Eugen Schoenle, MD20,
- Oddmund Sovik, MD21,
- Peter Swift, MD22,
- Rosa Maria Tsou, MD23,
- Maurizio Vanelli, MD24,
- Jan Åman, MD, PHD25 and
- For the Hvidøre Study Group on Childhood Diabetes
- 1Department of Paediatrics, Trinity College, National Children’s Hospital, Dublin, Ireland
- 2Ijsselland Hospital, Capelle, the Netherlands
- 3Pediatric University Clinic, Chieti, Italy
- 4Hospital for Sick Children, University of Toronto, Toronto, Canada
- 5Charité, Humboldt University, Berlin, Germany
- 6University Children’s Hospital, Queen Fabiola, Brussels, Belgium
- 7Department of Psychiatry, Trinity College, Dublin, Ireland
- 8Institut Saint Pierre, Montpellier, France
- 9University of Dundee, Dundee, United Kingdom
- 10University of Ulm, Ulm, Germany
- 11Novo Nordisk, Bagsværd, Denmark
- 12Peijas Hospital, Peijas, Finland
- 13Pediatric Clinic-Skopje, Skopje, Republic of Macedonia
- 14Novo Nordisk, Bagsværd, Denmark
- 15Endocrinologia Pediatrica Hospital De Cruces, Cruces, Spain
- 16Kitasato University School of Medicine, Kitasato, Japan
- 17Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
- 18Department of Pediatrics, Glostrup University Hospital, Glostrup, Denmark
- 19Royal Hospital for Sick Children, Glasgow, United Kingdom
- 20University Children’s Hospital, Zurich, Switzerland
- 21Haukeland Hospital, Bergen, Norway
- 22Leicester Royal Infirmary Childrens Hospital, Leicester, United Kingdom
- 23Hospital S. Joao, Porto, Portugal
- 24Department of Paediatrics, University of Parma, Italy
- 25Örebro Medical Centre Hospital, Örebro, Sweden
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.
RESEARCH DESIGN AND 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. HbA1c 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 HbA1c was 8.7% (range 4.8–17.4). Lower HbA1c 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 HbA1c 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.
Address correspondence and reprint requests to Professor Hilary M.C.V. Hoey, Department of Paediatrics, Trinity College, National Children’s Hospital, Tallaght, Dublin, 24, Ireland. E-mail:.
Received for publication 15 December 2000 and accepted in revised form 22 June 2001.
The parent and health professional questionnaires used in this study are available from H.H.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.