Live up to it

The Quality of Life in diabetics

The life of every person with diabetes is unique. However, almost every person with diabetes feels that the condition powerfully affects their lives, and most feel burdened by the manifold demands of their disease.

The emotional and social burdens felt by diabetics may be compounded by the acute physical distress of hypoglycemia or hyperglycemia and by the chronic distress of related complications.

Definition of quality of life

It is generally agreed upon that diabetes can affect a person's quality of life. Many persons ponder over what exactly we mean by quality of life?

In the most general terms, quality of life may be thought of as a multidimensional construct incorporating an individual's subjective perception of physical, emotional, and social well-being, including both a cognitive component (satisfaction) and an emotional component - that is happiness. However, health-related quality of life and diabetes-specific quality of life represent increasingly narrower concepts. As of today there is no "standard" for the assessment of overall, health-related, or diabetes-specific quality of life. Nevertheless, researchers all over the world are making constant efforts to develop such standards.

Its importance in diabetics

Quality of life has importance for people with diabetes and their health care providers for several reasons. This is because many people who suffer from diabetes and who have a poor quality of life often have a "to hell with it!" attitude toward their self-care, doing less than they should to manage their diabetes. When self care is diminished in diabetics, it in turn leads to worsened glycemic control, increased risks for complications, and exacerbation of diabetes in both the short run and the long run. Thus, quality-of-life issues are crucially important, because they may powerfully predict an individual's capacity to manage his disease and maintain long-term health and well-being.

These issues are especially critical for children and adolescents, who will probably spend many years living with diabetes. There is now good evidence that, among people with diabetes, factors like depression are stronger predictors of hospitalization and death than physical and metabolic factors such as presence of complications, body mass index, or higher levels of blood glucose.

Diabetics versus general population

Most studies report poor quality of life for people with diabetes compared to the general population, especially regarding physical functioning and well-being.

People with type 1 diabetes generally report better physical functioning and more energy than those with type 2 diabetes, though these differences are probably the result of factors that are associated with diabetes type, such as age or even treatment regimen. This reminds us of the frequently complex interplay among factors that influence quality of life. For those with type 2 diabetes, treatment intensification from diet alone to oral agents to insulin does seem to be associated with reduced quality of life.

For people with type 1 diabetes, some studies, including those conducted as part of the Diabetes Control and Complications Trial, indicate that treatment intensification has no effect on quality of life. However, other works suggest that intensification may enhance quality of life by reducing the immediate and chronic effects of hyperglycemia.

Glycemic control and quality of life

Some studies report a positive association between high levels of perceived quality of life and good glycemic control, especially when quality of life is assessed by disease-specific measures that capture relevant symptoms and feelings, and as long as good control is not accompanied by significant increases in treatment burden or hypoglycemia.

Factors that may affect quality of life

It has been observed that some demographic variables are associated with quality of life in people with diabetes, just as they are in the general population:

• Men generally report better quality of life than women.
• Younger people generally report better quality of life than older people.
• Those with more education or income generally report better quality of life than those with less of either.

Psychosocial factors

Apart from socio-demographic factors, the following psychosocial factors are also thought to affect the quality of life in diabetics. The effect of these factors may be direct, or they may be indirect, buffering the negative impact of diabetes or its demands. In fact, these psychosocial factors may be the most powerful predictors of quality of life, often outweighing the effects of important disease-related factors, such as complications

• Health-related beliefs
• Social support
• Coping style
• Personality type

Scope for improvement

Most quality-of-life instruments are developed for a particular purpose. Some quality-of-life measures focus on describing the perceived state of health of the individual in order to understand the patient's needs, desires, preferences, and expectations so that suitable medical and support services can be provided. In addition, health-related quality-of-life assessment has gained recognition as an important research tool for evaluating the impact of new medical treatments and health care services for people with diabetes.

However, the following can improve both glycemic control and quality of life in people with diabetes:

• Well studied and relevant blood glucose-lowering medications
• New insulin delivery systems
• Educational and counseling interventions
• Development of diabetes-specific coping skills

Among these factors, coping skills may be considered the critical one. This is because active and effective disease-specific coping can trigger a positive cascade of enhanced well-being, more active diabetes self-management, better glycemic control, and fewer complications.

In any case, better interventions and probably a lot of research needs to be done to provide a reasonably good quality of life to diabetics, as there is a global proliferation of the condition.

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