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PhD, Olenovych O.A.
Higher State Educational Establishment of
«Bukovinian State Medical University», Chernivtsi, Ukraine
IMPACT OF
HYPOGLYCEMIA ON HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH TYPE 2 DIABETES
MELLITUS
Introduction. The
ultimate goal of all health interventions and an outcomes measurement tool is a
quality of life (QoL), since it represents the effect of an illness on a
patient, denominates aspects of the health from the patient’s or subject’s point
of view (better expressed as «health-related quality of life» (HRQoL)) [8].
When regarding the impact on health,
diabetes mellitus (DM) is one of the most important chronic diseases in the
population. Negative impact of DM type 2 on patients’ QoL is connected with old
age, CHD and/or stroke, other macrovascular diseases, poor visual acuity,
obesity, concomitant diseases, etc. [2, 4, 7, 10] A variety of adverse clinical
outcomes in patients with DM type 2 is associated with hypoglycemia, which
undermines treatment adherence and itself represents a barrier to glycemic
control [4, 5]. Resulting in depression, lower treatment satisfaction, leading
to preventive coping behaviors (such as taking less insulin or increasing food
intake), hypoglycemia may negatively affect HRQoL [1, 3, 6, 8].
Considering that, the objective of this analysis was to
evaluate the relationships between symptomatic hypoglycemia and HRQoL in DM
patients type 2.
Materials
and methodology. To accomplish this, 20 patients with
diabetes mellitus type 2 (47% men and 53% women, mean age
– 60,9±1,44 years), hospitalized
to Chernivtsi Regional Endocrinological Center, participated
in the study. In 40% of participating patients the duration of
diabetes was less than 5 years, in 20% – 6-10
years, in 40% of patients had diabetes longer
than 10 years. Among all examined patients 40% were treated by oral
hypoglycemic agents, 60% were on combined hypoglycemic therapy. Enrolled
patients were subdivided into 2 groups (10 patients per each group): group 1 –
patients, who have experienced symptomatic hypoglycemic episodes, group 2 –
patients, who did not report a history of symptomatic hypoglycemia (data on the
frequency and severity of hypoglycemic episodes were not collected).
Except
standard clinical patients’ examination findings and information from medical
records, EuroQol five dimensions questionnaire (EQ-5D) was used
in order to assess health-related quality of life in the examined patients [9].
It is a standardized measure that rates 5 dimensions of health (mobility,
self-care, usual activities, pain/discomfort, anxiety/depression) across 3
levels (no problems, some/moderate problems, and extreme problems). The index
value (health utility) between 0 (death) and 1 (perfect health) was calculated
using the value sets (weights). Despite this questionnaire is easy to fill in,
the researcher accompanied the patients while they completed the questionnaires
to aid quality control during data collection.
Results and discussion. According
to the obtained findings, symptomatic hypoglycemia was associated with worse
HRQoL (lower EQ-5D score; P<0,05). Compared with group 2 patients, who did
not report a history of symptomatic hypoglycemia, patients with a confirmed
history of symptomatic hypoglycemia had lower scores on the EQ-5D index
(indicating poorer health status, P<0,001). This relationship was
demonstrated for both insulin and insulin secretagogues users.
This finding
suggests that hypoglycemia itself may be a more important predictor of patient
well-being and health status, than duration of diabetes. Probably, the rational
fear of hypoglycemia in patients with type 2 diabetes, experienced an event of
hypoglycemia, leads to worsening of metabolic control as well as tension with,
and a restriction of personal freedoms and responsibilities by, anxious and
overprotective loved ones, colleagues, or employers. Thus, it appears that in
group 1 patients fear of hypoglycemia is associated with lower HRQoL.
Conclusion. To sum up, in
patients with type 2 diabetes hypoglycemia imposes a significant physical and
psychological burden, being associated with lower HRQoL (overall health status,
mental health, and physical health). This substantiates an unmet need for
patient education programs that address patient fear of hypoglycemia and use of
medications with a lower risk of hypoglycemia.
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