Corresponding author: Alan M. Jacobson,
Diabetes Care. 2013 Oct;36(10):3131-8. doi: 10.2337/dc12-2109. Epub 2013 Jul 8.
To examine the long-term effects of type 1 diabetes treatment, metabolic control, and complications on health-related quality of life (HRQOL).
A total of 1,441 participants, initially 13-39 years of age, were followed for an average of 23.5 years as part of the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) follow-up study. The Diabetes Quality-of-Life questionnaire (DQOL) was administered annually during DCCT and every other year during EDIC. Biomedical data, including HbA1c levels, exposure to severe hypoglycemia, intercurrent psychiatric events, and development of diabetes complications were collected at regular intervals throughout the follow-up.
Mean total DQOL scores were not significantly different between the former DCCT intensive and conventional treatment groups (DCCT baseline, 78±8 vs. 78±9; EDIC year 17, 75±11 vs. 74±11). Over the course of the study, a drop of ≥5 points in DQOL score from DCCT baseline maintained on two successive visits occurred in 755 individuals and was associated with increased HbA1c, albumin excretion rate, mean blood pressure, BMI, and occurrence of hypoglycemic events requiring assistance. Lower DQOL scores after 23.5 years of follow-up were associated with prior development of retinopathy (P=0.0196), nephropathy (P=0.0019), and neuropathy (P<0.0001) as well as self-reported chest pain (P=0.0004), decreased vision in both eyes (P=0.0005), painful paresthesias (P<0.0001), recurrent urinary incontinence (P=0.0001), erectile dysfunction (P<0.0001), and history of psychiatric events (P<0.0001).
Among DCCT/EDIC participants, worsening metabolic control, serious diabetes complications and their associated symptoms, and development of psychiatric conditions led to decreased HRQOL.
研究 1 型糖尿病治疗、代谢控制和并发症对健康相关生活质量（HRQOL）的长期影响。
共有 1441 名参与者，年龄在 13-39 岁之间，作为糖尿病控制与并发症试验（DCCT）和糖尿病干预和并发症流行病学（EDIC）随访研究的一部分，平均随访 23.5 年。在 DCCT 期间每年进行一次糖尿病生活质量问卷（DQOL）调查，在 EDIC 期间每两年进行一次。在整个随访过程中，定期收集生物医学数据，包括 HbA1c 水平、严重低血糖暴露、并发精神事件以及糖尿病并发症的发展情况。
在 DCCT 强化和常规治疗组之间，平均总 DQOL 评分没有显著差异（DCCT 基线，78±8 vs. 78±9；EDIC 第 17 年，75±11 vs. 74±11）。在研究过程中，有 755 人在连续两次就诊时 DQOL 评分从 DCCT 基线下降≥5 分，与 HbA1c、白蛋白排泄率、平均血压、BMI 升高以及需要协助的低血糖事件发生有关。23.5 年随访后 DQOL 评分较低与先前发生视网膜病变（P=0.0196）、肾病（P=0.0019）和神经病变（P<0.0001）以及自述胸痛（P=0.0004）、双眼视力下降（P=0.0005）、疼痛性感觉异常（P<0.0001）、复发性尿失禁（P=0.0001）、勃起功能障碍（P<0.0001）和精神病史（P<0.0001）有关。
在 DCCT/EDIC 参与者中，代谢控制恶化、严重糖尿病并发症及其相关症状以及精神疾病的发展导致 HRQOL 下降。
