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Year : 2004  |  Volume : 50  |  Issue : 3  |  Page : 194

Does improved glycaemic control lead to a better short-term quality of life in diabetes mellitus type 2?


Institute for Medical Technology Assessment (iMTA), Erasmus University Medical Center, PO Box -1738, 3000 DR Rotterdam, Netherlands, The

Correspondence Address:
W K Redekop
Institute for Medical Technology Assessment (iMTA), Erasmus University Medical Center, PO Box -1738, 3000 DR Rotterdam
Netherlands, The
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How to cite this article:
Redekop W K. Does improved glycaemic control lead to a better short-term quality of life in diabetes mellitus type 2?. J Postgrad Med 2004;50:194

How to cite this URL:
Redekop W K. Does improved glycaemic control lead to a better short-term quality of life in diabetes mellitus type 2?. J Postgrad Med [serial online] 2004 [cited 2019 Dec 14];50:194. Available from: http://www.jpgmonline.com/text.asp?2004/50/3/194/12601


The long-term benefit of glycemic control in diabetes mellitus is to reduce the risk of complications (e.g., cardiovascular disease, nephropathy, neuropathy).[1],[2] Since these complications are known to reduce (health-related) quality of life (QOL),[3],[4] intensified glycaemic control is an important way to reduce risk of complications and improve QOL. However, what is the short-term effect of glycaemic control on QOL? In their one-year cohort study of the "Association between glycaemic control and quality of life in diabetes mellitus", Lau et al[5] observed an improvement in mental QOL but not physical QOL following reduction in HbA1c. While one is tempted to infer a cause-effect relationship, it is worthwhile to contemplate on other possible reasons for this finding. Possible explanations include chance, bias, and a non-causative association. Although the p-value of 0.042 is smaller than alpha=0.05, it indicates a 4.2% chance of seeing these results given no association between HbA1c and mental QOL. A larger sample size would resolve this problem. The association may also be due to bias (particularly selection bias). Despite some comparability in patient characteristics between study population and source population, it is still possible that the study population is unrepresentative of all patients. Minimal attrition and not a larger study population would rectify this; integration of QOL measurements into daily practice could also help.[6] A third explanation is a non-causative association. Such an association between change in HbA1c and change in mental QOL is possible, since lifestyle changes and therapy may influence both parameters.

Nevertheless, a causative association may be argued (e.g., based on biological plausibility). The relationship between HbAlc and QOL would not be linear in form but perhaps more an inverted U-curve, where either hypoglycaemia or hyperglycaemia would reduce QOL. Improvement in QOL would likely be greatest in cases of severe hyperglycaemia.

More research is needed to map out the relationship between glycaemic control and short-term QOL. As Lau et al suggest, cohort studies would be valuable here. In addition, such research would benefit from a better understanding of possible mechanisms (both biological and psychosocial) for how glycaemic control might affect short-term QOL. For example, the lack of association with physical QOL is curious and may be explained in various ways. Adoption of existing models will still require careful consideration of the dynamics of diabetes.[7]

 
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1.The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-86.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patient with type 2 diabetes mellitus (UKPDS 33). Lancet 1998;352:837-53.  Back to cited text no. 2    
3.UKPDS. Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). U.K. Prospective Diabetes Study Group. Diabetes Care 1999;22:1125-36.  Back to cited text no. 3    
4.Redekop WK, Koopmanschap MA, Stolk RP, Rutten GEHM, Wolffenbuttel BHR, Niessen LW. Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diab Care 2002;25:458-63.  Back to cited text no. 4    
5.Lau CY, Qureshi AK, Scott SG. Glycaemic control and quality of life in diabetes mellitus. J Postgrad Med 2004:50:189-95.  Back to cited text no. 5    
6.Greenhalgh J, Meadows K. The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: A literature review. J Eval Clin Pract 1999;5:401-16.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. J Amer Med Assoc 1995;273:59-65.  Back to cited text no. 7  [PUBMED]  



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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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