Predictive Factors of Quality of Life in Adults with Long-standing Type 1 Diabetes Mellitus

Abstract Background: To determine gender differences in Quality of life (QoL) perception and to identify sociodemographic, clinical and psychological characteristics associated with impaired QoL in adults with long-standing type 1 diabetes mellitus (DM1). Methods: Cross-sectional evaluation in a random cohort of DM1 adult patients from a tertiary care hospital. QoL was evaluated using translated and validated self-administered Diabetes QoL questionnaire (Es-DQoL), and results transformed into a 0-100 scale. Psychological assessment included a planned psychological interview and self-reported questionnaires (Beck Depression Inventory II, State-Trait Anxiety Inventory Form Y, Fear of hypoglycaemia Scale, Medical Outcomes Study Social Support Survey). Results: A total of 312 patients (51.6% male; 38.2 ± 12.7 years; HbA 1c 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.4 ± 12.0 years of DM1) were included in the analysis. Male and female subgroups showed similar sociodemographic and diabetes-related features and comparable social support. Among female patients, higher frequency of depression (31.7% vs. 14.9%, p<0.05) and anxiety (23.2% vs. 13.0%, p<0.05) and severity of depressive and anxious symptoms were also found. Compared to male patients, female patients showed a lower perception of QoL (75 [65-85] vs. 80 [69-87], p<0.05) and scored significantly worse in subscale Diabetes-related worries (69 [50-81] vs. 75 [62-88], p<0.05). Fear of hypoglycemia and severity of depressive and anxious symptoms, as well as the presence of macrovascular complications and high frequency of glycemic excursions were predictive factors of QoL. Conclusions: Adult women with long-standing DM1 showed a worse QoL perception probably related to higher frequency of psychopathological syndromes. Exposure to glycemic excursions and depressive and anxious symptoms were identified as modifiable, QoL-related variables. Educational, technological and psychological interventions aimed at reducing glycemic variability and improving psychological status are needed in order to improve QoL in DM1 patients.