Institute for Biometrics and Epidemiology, German Diabetes Centre (DDZ), Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
German Centre for Diabetes Research (DZD), Neuherberg, Germany.
Pediatr Diabetes. 2019 Aug;20(5):613-621. doi: 10.1111/pedi.12837. Epub 2019 Apr 16.
To investigate whether diabetic nephropathy (DN) is associated with lower quality of life (QOL) in youths with long-duration type 1 diabetes and whether associations differ by diabetes duration.
Overall, 1,462 youths aged 11 to 17 years with diabetes onset between 0 and 4 years of age and at least 10 years diabetes duration completed questionnaires on QOL between 2009 and 2016. Chronic generic and diabetes-specific QOL (diabetes impact and treatment scale) were assessed with three scales of the DISABKIDS instruments. Information on DN was obtained from the diabetes patient follow-up registry ("Diabetes-Patienten-Verlaufsdokumentation") with DN defined as micro- or macroalbuminuria. Linear regression analyses were used to evaluate the association between QOL and DN. To adjust for potential confounders, we applied inverse probability of treatment weighting for the linear regression.
In adjusted analysis, DN was associated with lower QOL in the chronic generic and the two diabetes-specific DISABKIDS scales. Overall, the observed effects were not clinically relevant but increased consistently with longer diabetes duration. Among those with at least 16 years diabetes duration, differences in QOL between patients with vs without DN were clinically relevant on the chronic generic scale (β = -10.3 [-21.0;0.7]).
The results suggest that long-term microvascular complications can impair chronic generic QOL already in youths with type 1 diabetes. Differences in QOL between patients with and without DN seem to increase with diabetes duration.
研究青少年起病的 1 型糖尿病患者中，糖尿病肾病（DN）是否与生活质量（QOL）降低相关，以及这种相关性是否因糖尿病病程而异。
2009 年至 2016 年期间，共有 1462 名年龄在 11 至 17 岁、糖尿病发病年龄在 0 至 4 岁之间且糖尿病病程至少 10 年的患者，完成了关于 QOL 的问卷调查。采用 DISABKIDS 仪器的三个量表评估慢性一般健康状况和糖尿病特异性 QOL（糖尿病影响和治疗量表）。通过糖尿病患者随访登记处（“Diabetes-Patienten-Verlaufsdokumentation”）获取 DN 信息，将微量白蛋白尿或大量白蛋白尿定义为 DN。线性回归分析用于评估 QOL 与 DN 之间的关系。为了调整潜在的混杂因素，我们对线性回归进行了逆概率处理加权。
在调整后的分析中，DN 与慢性一般健康状况和两个糖尿病特异性 DISABKIDS 量表的 QOL 降低相关。总体而言，观察到的影响虽无临床意义，但随着糖尿病病程的延长而持续增加。在糖尿病病程至少 16 年的患者中，DN 患者与无 DN 患者的 QOL 差异在慢性一般健康状况量表上具有临床意义（β=-10.3[21.0；0.7]）。
结果表明，长期微血管并发症可能会损害青少年 1 型糖尿病患者的慢性一般健康状况 QOL。DN 患者与无 DN 患者的 QOL 差异似乎随着糖尿病病程的延长而增加。
