[Well-being of insulin-dependent diabetics. Evaluation of 100 adolescents and young adults in relation to their metabolic control]

Abstract

Objective: The principal aim of therapeutic management of the child, adolescent and adult with type I diabetes is to avoid severe hypoglycemia and long-term complications, by maintaining blood glucose concentrations and thus glycated hemoglobin levels (HbA1c)-dose to the normal range. However, the therapeutic constraints should not decrease the quality of life and well-being of patients. Therefore, the purpose of the present study was to evaluate by a questionnaire the well-being of our autonomous diabetic adolescents and young adults in relationship with their HbA1c levels and other characteristics.

Patients and methods: A total of 100 unselected subjects (73 men and 44 women), with a mean age of 21 years (14-38) and a mean diabetes duration of 12 years (0-26), were included in the study over a 3-month period. Mean age at onset of diabetes was 10 years. Twenty-five percent of the patients were of Moroccan origin. All the patients were autonomous for self-management and treatment. Their socioeconomic status was not different from that of the normal population. The mean annual HbA1c level in the 100 diabetic patients was 7.3 (4.7-11.7). Well-being was measured using a questionnaire developed by a working group of the World Health Organisation, International Diabetes Federation and St Vincent Declaration. The questionnaire included 4 subscales labelled depression, anxiety, energy and positive well-being. The measurement of all 4 subscales involved 22 items and allowed an estimation of general well-being.

Results: General well-being in women was not as good as in men due to a greater tendency toward depression. Well being was better in patients with a professional activity than in the others. Patients age, duration of diabetes, number of insulin injections, frequency of home blood glucose monitoring, presence of 1 or 2 subclinical complications, had no effect on well-being. On the other hand, well-being was negatively correlated with the HbA1c levels: higher the HbA1c, higher the anxiety and the depression, and lower the energy and the positive well-being.

Conclusion: Well-being was mainly associated with HbA1c levels; it improved with better glucemic control.