Uticaj različitih režima insulinske terapije na kvalitet života obolelih od dijabetesa melitusa tipa 1

Abstract

Uvod/Cilj. Uprkos savremenom lečenju dijabetesa melitusa (DM), jedna polovina bolesnika ne postiže optimalnu metaboličku kontrolu. S obzirom na veliko psihičko opterećenje obolelih od DM, cilj ovog rada bio je da ispita uticaj različitih režima insulinske terapije, kvaliteta glikoregulacije i prisustva vaskularnih komplikacija na subjektivnu procenu bolesnika o njihovom kvalitetu života. Metode. Bolesnici lečeni od DM tipa 1 (n = 122) kontrolisani u endokrinološkoj ambulanti Kliničko-bolničkog centra 'Zvezdara' svrstani su u četiri grupe prema režimima insulinske terapije: 26 bolesnika bilo je na kontinuiranoj supkutanoj insulinskoj infuziji insulinskom pumpom, 30 bolesnika na konvencionalnoj insulinskoj terapiji, 33 na intenziviranoj terapiji humanim insulinima, a 33 na intenziviranoj terapiji insulinskim analozima. Procena kvaliteta života vršena je pomoću tri upitnika: WHO-5 (za procenu emocionalnog blagostanja), SF-36 (opšta zdravstvena anketa) i ITAS upitnik (za procenu stava prema insulinskoj terapiji). Procena metaboličke kontrole vršena je analizom glikoliziranog hemoglobina (HbA1c), lipidnog statusa i prisustva glikoziliranog komplikacija. U ovoj studiji preseka korišćene su sledeće metode statističke analize: deskriptivna statistika, t-test, χ² test, tabele kontingencije, ANOVA i metode korelacije. Rezultati. Bolesnici na insulinskoj pumpi imali su značajno bolju metaboličku kontrolu od drugih bolesnika, naročito od onih na konvencionalnoj terapiji (HbA1c na pumpi 7,07 ± 1,48% vs. HbA1c na konvencionalnoj terapiji 10,04 ± 1,44; p = 0,000). Nije uočena razlika među grupama na intenziviranoj terapiji humanim insulinima ili insulinskim analozima. Dobra metabolička kontrola značajno je uticala na kvalitet života. Postojanje retinopatije i nefropatije značajno je umanjilo fizičko blagostanje, a polineuropatije i kardiovaskularnih komplikacija i fizičko i mentalno blagostanje. Zaključak. Izbor režima insulinske terapije značajno utiče ne samo na metaboličku kontrolu, nego i na kvalitet života bolesnika.

Background/Aim. Despite of contemporary diabetes mellitus (DM) treatment, one half of patients do not achieve an optimal metabolic control. Considering great psychological burden of diabetic patients, the purpose of this study was to assess the effect of different insulin treatment regimens, glycemic control and the presence of vascular complications on self-reported well-being and quality of life (QoL) of subjects with type 1 DM. Methods. The patients with type 1 DM (n = 122) recruited from the outpatient Diabetes Endocrinology Clinic of Zvezdara University Medical Center were divided into 4 groups according to the specific treatment regimen: 26 were on continuous subcutaneous insulin infusion (CSII), 30 on conventional insulin therapy, 33 on multiple daily injections (MDI) with human insulins, and 33 on MDI with insulin analogues. QoL was assesed by self-reported well-being with the following questionnaires: WHO-5 item Well Being Index (WHO- 5), 36 item Short Form (SF-36) survey, and Insulin Treatment Appraisal Scale (ITAS). Objective metabolic control was assessed by glycosylated hemoglobin (HbA1c), lipid levels and the presence of vascular complications. Statistical analyses used in this crosssectional study included: descriptive statistics, Student's t-test, Chisqare test, contingency tables, ANOVA and correlation methods. Results. The patients on CSII had significantly better metabolic control than all other treatment groups, especially when compared to the one on conventional therapy (CSII HbA1c 7.07 ± 1.48% vs conventional therapy, HbA1c 10.04 ± 1.44; p = 0.000). No significant difference in glycemic control was observed between patients on MDI with human insulins and insulin analogues. Good glycemic control significantly influenced the reported QoL. The patients with retinopathy and nephropathy reported significantly lower physical well-being, and the patients with polyneuropathy and cardiovascular complications reported also lower psychological well being. Conclusions. Insulin treatment regiment selection affects not only objective metabolic control, but also QoL.