Treatment modality, quality of life, and patient-perceived difficulties in the treatment of diabetes

Orly Tamir, Julio Wainstein, Itamar Raz, Joshua Shemer, Anthony Heymann

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Clinical evidence points to patient-perceived difficulties and compliance problems in implementing early insulin therapy. Therefore, individual treatment aims are necessary to optimize diabetes therapy, as currently acknowledged by new ADA/EASD guidelines. The better characterization of patient-perceived difficulties in the implementation of early insulin treatment may contribute to improved compliance and optimal tailoring of treatment regimens for the individual patient. Objectives: To assess differences in QoL and patient-perceived difficulties in care with every addition of OHA, and insulin therapy. Research design and methods: Analysis was conducted on crosssectional sample of 714 diabetic patients treated with OHAs or with insulin once or twice daily. Differences in diabetes-specific QoL, overall QoL and perception of difficulties associated with specific diabetes-treatment attributes were evaluated using trend analysis and comparisons between groups. The contribution of each diabetes-treatment attribute to QoL measures and glycemic control was also assessed. Results: No significant difference was found in QoL measures among patients treated exclusively with OHAs when these were assessed according to number of oral agents, irrespective of degree of glycemic control. Better controlled patients treated with 2-OHAs compared with poorly controlled patients treated with single OHA had lower perception of difficulty associated with diabetes-treatment attributes. Patients poorly controlled treated with 2-OHAs and patients better controlled treated with 3-OHAs had similar QoL and perceived difficulties in care. However, the insulin-based alternative was consistently associated with significant higher perception of pain when compared to each oral regimen, as well as lower overall QoL. Multivariate models accounted for 52% and 32% of the variance in QoL measures. Conclusions: From the patients' perspective, oral therapy is the preferable strategy to reach treatment goals since addition of OHAs was not associated with lower QoL or patient-perceived difficulty in care. If early insulin treatment is considered, physicians should address specific diabetes-treatment characteristics, mainly the issue of pain, in order to promote improved QoL and disease control.

Original languageEnglish
JournalReview of Diabetic Studies
Volume9
Issue number1
StatePublished - 2012

Keywords

  • Diabetes mellitus
  • Insulin treatment
  • Oral hypoglycemic therapy
  • Patient perception
  • Quality-of-life

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