Dynamics and determinants of long-term quality of life in children and adolescents with type 1 diabetes: real-world evidence from China

PurposesChildren and adolescents with type 1 diabetes (T1D) experience persistent impacts on quality of life (QoL). While most previous studies have relied on cross-sectional designs, this prospective cohort study intended to: (1) assess longitudinal changes in patient-reported QoL over a three-year period; (2) identify distinct QoL trajectory subgroups; and (3) examine demographic, physiological, psychological, and clinical determinants associated with trajectory membership and multidimensional QoL outcomes.MethodsTwo hundred children and adolescents with T1D from China were followed for three years in a longitudinal cohort study. QoL was measured using the Quality of Life Scale for Children and Adolescents (QLSCA) at baseline from June 2019 to May 2020, with follow-up visits at years 1, 2, and 3 thereafter. Trajectories of QoL and associations with determinants were identified via iterative estimations of group-based trajectory models and multivariable multinomial logistic regression, respectively. The specific impacts of the determinants on QoL were revealed using multiple linear regressions. Changes in QoL dimensions over time were examined using linear mixed models, while changes in determinants were analyzed using both linear mixed models and generalized estimating equations.ResultsFour QoL trajectory groups were identified (N = 200): poor (19.5%), moderate (27.5%), improving (17.5%), and good (35.5%) QoL. Improved QoL was associated with higher paternal education, greater height, lower glycosylated hemoglobin (HbA1c), fewer hypoglycemic episodes, and reduced depression levels. Furthermore, the frequency of self-monitoring of blood glucose (SMBG), Self-Management of Type 1 Diabetes for Adolescents (SMOD-A) scores, and higher parental education were positively correlated with improvements in various QoL dimensions. In contrast, higher State-Trait Anxiety Inventory-Trait (STAI-T) and Children's Depression Inventory (CDI) scores were negatively correlated with relationship between teacher and pupil, negative emotions, and other QoL aspects. Throughout the study, a significant increase in the use of continuous glucose monitoring (CGM) and insulin pumps was observed, along with improvements in SMBG and self-management ability. Notably, a reduction in the monthly frequency of hypoglycemic episodes and anxiety levels was also observed. Statistically significant improvements were found across several QoL dimensions, including companionship, self-esteem, physical feeling, activity opportunity, and physical activity ability, with the most pronounced improvement seen in physical activity ability.ConclusionThis study identified the dynamic trajectories of QoL changes in a cohort of children and adolescents with T1D and screened potential determinants that enhance QoL. These insights are valuable for developing tailored, individualized diabetes management strategies aimed at improving long-term outcomes for T1D patients.