Castellano-Guerrero Ana María, Guerrero Raquel, Ruiz-Aranda Desireé, Perea Sofia, Pumar Alfonso, Relimpio Federico, Mangas Miguel Angel, Losada Fernando, Martínez-Brocca Maria Asunción
Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Avenida Dr Fedriani 3, 41009 Seville, Spain.
Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Seville, Spain.
Diabetol Metab Syndr. 2020 Jul 17;12:64. doi: 10.1186/s13098-020-00571-x. eCollection 2020.
To assess gender differences in Quality of life (QoL) and in sociodemographic, clinical and psychological factors associated with impaired QoL in adults with long-standing type 1 diabetes mellitus (DM1).
Cross-sectional evaluation in a random cohort of DM1 adult patients from a tertiary care hospital. QoL was evaluated using translated and validated self-administered Diabetes QoL questionnaire (Es-DQoL), and results transformed into a 0-100 scale. Psychological assessment included a planned psychological interview and self-reported questionnaires (Beck Depression Inventory II, State-Trait Anxiety Inventory Form Y, Fear of hypoglycaemia Scale, Medical Outcomes Study Social Support Survey).
A total of 312 patients (51.6% male; 38.2 ± 12.7 years; HbA 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.4 ± 12.0 years of DM1) were included in the analysis. Male and female subgroups showed similar sociodemographic and diabetes-related features and comparable social support. Among female patients, higher frequency of depression [31.7% (IC95% 26.2-40.8) vs. 14.9% (IC95% 10.1-20.8), p < 0.05] and anxiety [23.2% (IC95% 19.3-33.14) vs. 13.0% (IC95% 8.1-18.4), p < 0.05] and severity of depressive and anxious symptoms were also found. Compared to male patients, female patients showed lower QoL [75 (IC95% 73.6-77.5) vs. 80 (IC95% 75.7-83.1), p < 0.05] and scored significantly worse in subscale Diabetes-related worries [69 (IC95% 50.0-81.0) vs. 75 (IC95% 72.9-79.0), p < 0.05]. Fear of hypoglycemia and severity of depressive and anxious symptoms were factors independently associated to lower QoL in men and women while high frequency of glycemic excursions was a female-specific predictive one.
Adult women with long-standing DM1 showed lower QoL probably related to higher frequency and severity of psychopathological syndromes. Depressive and anxious symptoms and, among women, exposure to glycemic excursions were identified as modifiable, QoL-related variables. Educational, technological and psychological interventions are needed in order to improve QoL in DM1 patients.
评估长期 1 型糖尿病（DM1）成年患者的生活质量（QoL）的性别差异，以及与生活质量受损相关的社会人口学、临床和心理因素。
对一家三级护理医院的 DM1 成年患者随机队列进行横断面评估。使用经翻译和验证的自我管理糖尿病生活质量问卷（Es-DQoL）评估生活质量，并将结果转换为 0-100 分制。心理评估包括计划好的心理访谈和自我报告问卷（贝克抑郁量表 II、状态-特质焦虑量表 Y 型、低血糖恐惧量表、医学结局研究社会支持调查）。
共纳入 312 例患者（男性占 51.6%；年龄 38.2±12.7 岁；糖化血红蛋白 7.5±1.1%（58.5±14.2 mmol/mol）；DM1 病程 20.4±12.0 年）进行分析。男性和女性亚组在社会人口学和糖尿病相关特征方面相似，社会支持相当。在女性患者中，还发现抑郁[31.7%（95%置信区间 26.2-40.8）对 14.9%（95%置信区间 10.1-20.8），p<0.05]和焦虑[23.2%（95%置信区间 19.3-33.14）对 13.0%（95%置信区间 8.1-18.4），p<0.05]的发生率更高，抑郁和焦虑症状的严重程度也更高。与男性患者相比，女性患者的生活质量较低[75（95%置信区间 73.6-77.5）对 80（95%置信区间 75.7-83.1），p<0.05]，在糖尿病相关担忧子量表中的得分明显更差[69（95%置信区间 50.0-81.0）对 75（95%置信区间 72.9-79.0），p<"="" 0.05]。低血糖恐惧以及抑郁和焦虑症状的严重程度是男性和女性生活质量较低的独立相关因素，而血糖波动频繁是女性特有的预测因素。
长期患 DM1 的成年女性生活质量较低，可能与心理病理综合征的较高发生率和严重程度有关。抑郁和焦虑症状以及女性中的血糖波动被确定为与生活质量相关的可改变变量。需要进行教育、技术和心理干预以改善 DM1 患者的生活质量。
