Diabetes Care, Vol 21, Issue 6 919-924, Copyright © 1998 by American Diabetes Association

ARTICLES

Well-being and symptoms in relation to insulin therapy in type 2 diabetes

JJ de Sonnaville, FJ Snoek, LP Colly, W Deville, D Wijkel and RJ Heine
Research Centre Primary/Secondary Health Care, Vrije Universiteit, Amsterdam, The Netherlands.

OBJECTIVE: To determine the influence of insulin therapy on physical symptoms, emotional and general well-being, and treatment satisfaction in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A descriptive prospective 2-year cohort study was performed. The study population consisted of 272 eligible NIDDM patients of Dutch origin > or = 40 years of age who had a known diabetes duration > or = 3 months and who were treated with diet and/or oral hypoglycemic agents. Dependent variables in the logistic regression analysis were scores on the Type 2 Diabetes Symptom Checklist, the Profile of Mood States, and questions regarding general well-being and treatment satisfaction. Potential determinants under study were age, sex, known diabetes duration, insulin dose, duration of insulin therapy, comorbidity, baseline and change in metabolic parameters and cardiovascular risk factors. RESULTS: A baseline and 2-year questionnaire were available for 157 patients (58%). During follow-up, 39 of them (24.8%) were treated with insulin. Initiation of insulin therapy was significantly associated with improved glycemic control (mean HbA1c 8.2 +/- 1.4 [SD] to 7.4 +/- 0.9%, P = 0.001) and weight gain (BMI 27.1 +/- 3.9 to 28.6 +/- 4.3 kg/m2, P = 0.000). Of all symptom and well-being scores, only feelings of emotional fatigue worsened significantly, although modestly (0.4-1.7 on a scale of 0.0-10.0, P = 0.02). Although diabetes management with insulin was experienced as more demanding (P = 0.04), treatment satisfaction scores were not adversely influenced (2.5-1.9, P = 0.39). High insulin doses were significantly and independently associated with high symptom scores (total score, hypoglycemic score) and with low mood (displeasure score, anger, tension, emotional fatigue) and perceived state of health. CONCLUSIONS: Initiation of insulin therapy in type 2 diabetes improves glycemic control effectively, has little influence on physical and psychological well-being dimensions, and does not affect treatment satisfaction.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				E. B. Fisher, C. T. Thorpe, B. M. DeVellis, and R. F. DeVellis Healthy Coping, Negative Emotions, and Diabetes Management: A Systematic Review and Appraisal The Diabetes Educator, November 1, 2007; 33(6): 1080 - 1103. [Abstract] [Full Text] [PDF]

				A. I. Vinik and Q. Zhang Adding Insulin Glargine Versus Rosiglitazone: Health-related quality-of-life impact in type 2 diabetes Diabetes Care, April 1, 2007; 30(4): 795 - 800. [Abstract] [Full Text] [PDF]

				C. Carver Insulin Treatment and the Problem of Weight Gain in Type 2 Diabetes The Diabetes Educator, November 1, 2006; 32(6): 910 - 917. [Abstract] [Full Text] [PDF]

				R. P. Hayes, L. Bowman, P. O. Monahan, D. G. Marrero, and C. A. McHorney Understanding diabetes medications from the perspective of patients with type 2 diabetes: prerequisite to medication concordance. The Diabetes Educator, May 1, 2006; 32(3): 404 - 414. [Abstract] [Full Text] [PDF]

				A. Fritsche, M. A. Schweitzer, H.-U. Haring, and the 4001 Study Group* Glimepiride Combined with Morning Insulin Glargine, Bedtime Neutral Protamine Hagedorn Insulin, or Bedtime Insulin Glargine in Patients with Type 2 Diabetes: A Randomized, Controlled Trial Ann Intern Med, June 17, 2003; 138(12): 952 - 959. [Abstract] [Full Text] [PDF]