Effects of metabolic control, patient education and initiation of insulin therapy on the quality of life of patients with type 2 diabetes mellitus

Objective: The objective of this study was to evaluate the impact of initiation of insulin therapy, metabolic control and structured patient education on the diabetes-related quality of life (QoL) in insulin-treated patients with type 2 diabetes mellitus. Methods: This prospective study was conducted with 71 consecutively recruited patients with insulin-treated diabetes at the University hospital. All patients participated an inpatient diabetes treatment and teaching program (DTTP) for conventional insulin therapy (mean age 68.9 years, HbAlc 10.1 +/- 1.4%, diabetes duration 11.2 years (range: 0-25.5 years), body-mass-inclex 28.7 +/- 5.7 kg/m(2). Diabetes-related quality of life was assessed before and 6 months after participation in the DTTP using the standardized questionnaire of Lohr analysing the subscales: social relations, physical complaints, worries about the future, dietary restrictions, fear of hypoglycaemia, and daily struggles. Results: Only patients switched on insulin therapy showed significant improvement in diabetes-related quality of life 6 months after participation in the DTTP (p = 0.03), fewer physical complaints (p = 0.03), fewer worries about the future (p = 0.02), fewer daily struggles (p = 0.01) and less fear of hypoglycaemia (p < 0.001), while patients, who were already on insulin therapy showed no improvements in diabetes-related quality of life. Though, residual analysis reveals that effects on patients' QoL are mainly caused by improvements in metabolic control. Conclusions: Improvements in metabolic control have a significant effect on different diabetes-related quality of life domains in patients with diabetes mellitus. Practice implications: Appropriate interventions resulting in better metabolic control. such as starting oil insulin therapy within a structured patient education program seem to be an effective approach to improve patients' diabetes-related quality of life. (C) 2008 Elsevier Ireland Ltd. All rights reserved.