Quality of Life Measures Critical in Diabetes Management

Diabetes care and treatment goes beyond measuring and maintaining blood glucose levels. Health-related quality of life (HRQOL) is an important area of investigation that continues to gain recognition and is a critical element of diabetes research, treatment, and care, according to a panel of experts who discussed this topic during a symposium at the ADA’s 76th Scientific Sessions (June 10-14, 2016; New Orleans, LA).

“Patient quality of life can be a better predictor of mortality and morbidity than some biologic measures,” said Lawrence Fisher, PhD, University of California, San Francisco, in a press statement.

He emphasized the importance of incorporating a comprehensive HRQOL assessment into the structure of trials. “Patients provide a perspective that investigators can often miss. Early and continuous patient feedback is crucial for us to develop and employ the most effective strategies that can improve quality-of -life and biologic outcome measures,” he said.

Quality-of-life benefits have been demonstrated in long-term diabetes studies, as shown in the Look AHEAD (Action for Health in Diabetes) trial. Look AHEAD was designed to test whether intensive lifestyle intervention (ILI)—healthy eating and increased physical activity—for weight loss could reduce the occurrence of cardiovascular disease, stroke, and cardiovascular-related deaths in obese and overweight people with type 2 diabetes.

Gareth R Dutton, PhD, University of Alabama, Tuscaloosa, reviewed findings from Look AHEAD that have been published in the literature.

Versus participants who received diabetes support and education (DSME, n = 2575), study participants who received ILI (n = 2570) achieved significantly greater weight loss at the end of the study (6% vs 3.5%, respectively). The ILI group also experienced significant quality-of-life improvements such as improvements in physical function and mobility. Additionally, the ILI group was also 15% less likely to experience elevated symptoms of depression 8 years following treatment initiation.

“The results highlight the need to consider a variety of benefits for patients with type 2 diabetes who are able to lose a modest amount of weight,” said Dr Dutton. “Many of the outcomes we measured, including physical functioning, mobility, and depressive symptoms, are very important to patients who are understandably interested in maximizing their quality of life and maintaining their independence for as long as possible.”

Researchers are looking at quality-of-life measures for people with type 1 diabetes and their caregivers as well. Marisa E Hilliard, PhD, assistant professor of pediatrics, Baylor College of Medicine, and Texas Children’s Hospital, Houston, discussed preliminary qualitative findings from her research team’s mixed-methods study. The researchers are currently interviewing individuals with type 1 diabetes and their caregivers in order to better understand the quality of life issues they experience at different points in life. She said several themes have emerged from an analysis of the interviews conducted to date, such as “worries about life with diabetes, challenges of managing diabetes care expenses, and the importance of supportive communication among family members and health care providers.”

“By creating a suite of quality of life measures that extend across the lifespan and can be used with both people with diabetes and their caregivers, we anticipate the measures will allow for consistent, longitudinal and outcomes research that can more accurately evaluate the impact of treatments and therapies on everyday life,” said Dr Hilliard. “This will help bring to market new intervention approaches that meet more needs of people with and impacted by diabetes.”—Eileen Koutnik-Fotopoulos