Dłużniak-Gołaska Karolina, Szostak-Węgierek Dorota, Panczyk Mariusz, Szypowska Agnieszka, Sińska Beata
Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland.
Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland.
Patient Prefer Adherence. 2019 Sep 20;13:1589-1597. doi: 10.2147/PPA.S206969. eCollection 2019.
Appropriate health-related quality of life (HRQOL) in children and adolescents with type 1 diabetes constitutes one of the most important factors that determine treatment effectiveness. There are numerous studies which tackle the issue of the relationship between HRQOL and various clinical and demographic factors, including gender. Therefore, the aim of the present study was to assess HRQOL and identify factors by which it may be affected, with particular emphasis on gender.
The study group included 197 girls and boys (13.9±2.33 years old) with a history of type 1 diabetes (>1 year) treated with the use of insulin pumps. PedsQL Diabetes Module 3.0 questionnaire was used in the assessment of HRQOL. Multivariate linear regression with gender as a covariate was used to investigate the relationship between total PedsQL score and selected variables associated with patient characteristics, insulin dosage and the control of glycemia. Moreover, the presence of gender differences was verified in terms of variables which significantly affected HRQOL.
Significantly higher results were observed in boys as regards the total PedsQL score (70.8±11.91 vs 62.4±13.91; <0.001) and individual subscales of the questionnaire (except "Worry"). Regression analysis demonstrated the presence of a significant negative relationship between HRQOL assessment and HbA1c concentrations, WHtR value and the frequency of hypoglycemic episodes. However, it was noted that better HRQOL was observed in boys than in girls, regardless of the quality of the metabolic control of diabetes, regular pattern of adipose tissue distribution and experiencing hyperglycemic episodes.
Female gender was an independent factor which adversely affected HRQOL. Other factors which negatively influenced HRQOL included poor metabolic control of diabetes, central distribution of adipose tissue and frequent episodes of hyperglycemia. It seems necessary to focus also on other factors that may potentially influence HRQOL of patients with type 1 diabetes.
1型糖尿病儿童和青少年的健康相关生活质量（HRQOL）适宜与否是决定治疗效果的最重要因素之一。有许多研究探讨了HRQOL与各种临床和人口统计学因素（包括性别）之间的关系。因此，本研究的目的是评估HRQOL并确定可能影响它的因素，特别强调性别因素。
研究组包括197名患有1型糖尿病（病程>1年）且使用胰岛素泵治疗的女孩和男孩（年龄13.9±2.33岁）。使用儿童生活质量量表糖尿病模块3.0问卷评估HRQOL。以性别作为协变量的多元线性回归用于研究儿童生活质量量表总得分与所选变量（与患者特征、胰岛素剂量和血糖控制相关）之间的关系。此外，还针对显著影响HRQOL的变量验证了性别差异的存在。
在儿童生活质量量表总得分（70.8±11.91对62.4±13.91；<0.001）以及问卷的各个子量表（“担忧”子量表除外）方面，男孩的得分显著更高。回归分析表明，HRQOL评估与糖化血红蛋白（HbA1c）浓度、腰高比（WHtR）值及低血糖发作频率之间存在显著负相关。然而，值得注意的是，无论糖尿病代谢控制质量、脂肪组织分布规律与否以及是否经历高血糖发作，男孩的HRQOL均优于女孩。
女性性别是对HRQOL产生不利影响的独立因素。其他对HRQOL产生负面影响的因素包括糖尿病代谢控制不佳、脂肪组织的中心性分布以及频繁的高血糖发作。似乎有必要关注其他可能潜在影响1型糖尿病患者HRQOL的因素。
