Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Front Endocrinol (Lausanne). 2021 Mar 10;12:573235. doi: 10.3389/fendo.2021.573235. eCollection 2021.
Many individuals with type 2 diabetes mellitus (T2DM) experience "psychological insulin resistance". Consequently, it could be expected that insulin therapy may have negative effects on psychological outcomes and well-being. Therefore, this study compared health status and psychosocial functioning of individuals with T2DM using only oral antihyperglycemic agents (OHA) and on insulin therapy (with or without OHA).
In this cross-sectional study, we used baseline data of a cluster randomized controlled trial conducted in 55 Dutch general practices in 2005. Health status was measured with the Short Form (SF)-36 (scale 0-100) and psychosocial functioning with the Diabetes Health Profile (DHP, scale 0-100). To handle missing data, we performed multiple imputation. We used linear mixed models with random intercepts per general practice to correct for clustering at practice level and to control for confounding.
In total, 2,794 participants were included in the analysis, their mean age was 65.8 years and 50.8% were women. Insulin-users (n = 212) had a longer duration of T2DM (11.0 versus 5.6 years) and more complications. After correcting for confounders and multiple comparisons, insulin-users reported significantly worse outcomes on vitality (SF-36, adjusted difference -5.7, p=0.033), general health (SF-36, adjusted difference -4.8, p=0.043), barriers to activity (DHP, adjusted difference -7.2, p<0.001), and psychological distress (DHP, adjusted difference -3.7, p=0.004), all on a 0-100 scale.
While previous studies showed similar or better health status in people with type 2 diabetes receiving insulin therapy, we found that vitality, general health and barriers to activity were worse in those on insulin therapy. Although the causality of this association cannot be established, our findings add to the discussion on the effects of insulin treatment on patient-reported outcomes in daily practice.
许多 2 型糖尿病（T2DM）患者存在“心理胰岛素抵抗”。因此，可以预期胰岛素治疗可能对心理结果和幸福感产生负面影响。因此，本研究比较了仅使用口服降糖药（OHA）和（或）胰岛素治疗的 T2DM 患者的健康状况和社会心理功能。
在这项横断面研究中，我们使用了 2005 年在 55 家荷兰普通诊所进行的一项集群随机对照试验的基线数据。健康状况用简短形式（SF）-36（量表 0-100）测量，社会心理功能用糖尿病健康状况量表（DHP，量表 0-100）测量。为了处理缺失数据，我们进行了多次插补。我们使用线性混合模型，每个普通诊所具有随机截距，以校正诊所水平的聚类，并控制混杂因素。
共有 2794 名参与者纳入分析，平均年龄为 65.8 岁，50.8%为女性。胰岛素使用者（n=212）的 T2DM 病程更长（11.0 年 vs. 5.6 年），且并发症更多。在控制混杂因素和多次比较后，胰岛素使用者在活力（SF-36，调整差异-5.7，p=0.033）、一般健康（SF-36，调整差异-4.8，p=0.043）、活动障碍（DHP，调整差异-7.2，p<0.001）和心理困扰（DHP，调整差异-3.7，p=0.004）方面的报告结果明显更差，所有结果均在 0-100 量表上。
虽然之前的研究表明，接受胰岛素治疗的 2 型糖尿病患者的健康状况相似或更好，但我们发现，接受胰岛素治疗的患者在活力、一般健康和活动障碍方面的情况更差。尽管不能确定这种关联的因果关系，但我们的研究结果增加了关于胰岛素治疗对日常实践中患者报告结果的影响的讨论。
