Comparison of psychiatric morbidity and disease specific quality of life in patients of diabetes treated with insulin versus oral hypoglycemics
Keywords:Diabetes, Insulin, Oral hypoglycemics, Disease specific quality of life
Background: Psychiatric co-morbidity along with other disease and treatment related factors including treatment modality (i.e. insulin versus oral agents) affect the quality of life of diabetic patients significantly. The aim and objectives of the study was to study psychiatric morbidity and quality of life and relationship between these factors in patients of type-2 diabetes being treated with insulin versus oral hypoglycemics.
Methods: A cross sectional study with patients of type-2 diabetes 50 each taking insulin and oral hypoglycemics was carried out in the endocrinology outpatient department and wards of the tertiary teaching municipal medical institute in Mumbai. Subjects were assessed using QOLID (quality of life instrument for Indian diabetic patients) and SCL-90R (symptoms checklist 90 revised). Software used was SPSS-19. Data was analyzed using Pearson’s bivariate correlation and unpaired t-test according to applicability.
Results: 76% of subjects on insulin while 82% on oral hypoglycemics had satisfactory quality of life. There was no statistically significant difference in the two groups on quality of life. (t= -1.130, p=0.261). 46% of patients on insulin and 40% on oral hypoglycemics had significant psychopathology. Highest scores were found on depression, somatization and obsessive compulsive symptoms in both groups; however there was no significant difference in the two groups on either global score or the subscales of SCL-90R. Increase in psychopathology was associated with decrease in quality of life (negative correlation) in diabetics as a whole (R= -0.748, p=0.000) as well as on all subscales. Female gender was associated with better quality of life while male gender, age, duration of illness, blood glucose levels and presence of associated complications with poor QOL.
Conclusion: Treatment modality does not seem to affect quality of life or psychopathology in diabetic patients and increased psychopathology is associated with poor quality life in them.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
Huizinga MM, Rothman RL. Addressing the diabetes pandemic: a comprehensive approach. Indian J Med Res. 2006;124:481-4.
Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, eds. Diabetes Atlas. International Diabetes Federation. 3rd ed. Belgium: International Diabetes Federation; 2006:15-103.
Singh H, Bradley C. Quality of life in diabetes. Int J Diabetes Dev Ctries. 2006;26(1):7-10.
Bradley C, Speight J. Patient perceptions of diabetes and diabetes therapy: assessing quality of life. Diabetes Metab Res Rev. 2002;18(Suppl 3):S64-9.
Eiser C, Tooke JE. Quality of life in type II diabetes: evaluation and applications. Pharmacoeconomics. 1995;8(Suppl 1):17-22.
Wexler DJ, Grant RW, Wittenberg E, Bosch JL, Cagliero E, Delahanty L et al. Correlates of health-related quality of life in type 2 diabetes. Diabetologia. 2006;49(7):1489-97.
Cohen S, Rodriguez MS. Pathways linking affective disturbances and physical disorders. Health Psychol. 1995;14:374-80.
Gavard JA, Lustman PJ, Clouse RE. Prevalence of depression in adults with diabetes: an epidemiological evaluation. Diabetes Care. 1993;16:1167-78.
Lustman PJ, Griffith LS, Clouse RE. Depression in adults with diabetes. Sem Clin Neuropsychiatr. 1997;2:15-23.
Vinogradova Y, Coupland C, Hippisley-Cox J, Whyte S, Penny C. Effects of severe mental illness on survival of people with diabetes. Br J Psychiatry. 2010;197:272-7.
Balhara YPS .Diabetes and psychiatric disorders. Indian J Endocrinol Metab. 2011;15(4):274-83.
Mayou R, Bryant B, Turner R. Quality of life in non-insulin dependent Diabetes and a comparison with insulin dependent Diabetes. J Psychosom Res. 1990;34:1-11.
Maddigan SL, Majumdar SR, Toth EL, Feeny DH, Johnson JA. Health-related quality of life deficits associated with varying degrees of disease severity in type 2 diabetes. Health Qual Life Outcomes. 2003;1(1):78.
Jacobson AM, Degroot M, Samson J. The evaluation of two measures of quality of life in patients of Diabetes. Endo pract. 2004;10:502-8.
Hemmingsen B, Christensen LL, Wetterslev J, Vaag A, Gluud C, Lund SS et al. Comparison of metformin and insulin versus insulin alone for type 2 diabetes: systematic review of randomised clinical trials with meta-analyses and trial sequential analyses. BMJ. 2012;344:1-19.
Derogatis LR, Savitz KL. The SCL-90-R, Brief Symptom Inventory, and Matching Clinical Rating Scales. In The Use of Psychological Testing For Treatment Planning And Outcomes Assessment, Maruish ME. Hillsdale NJ, eds. Lawrence Erlbaum Associates Publishers. 1994:217-48.
Nagpal J, Kumar A, Kakar S, Bhatia A. The Development of Quality of Life Instrument for Indian Diabetes Patients (QOLID): a Validation and Reliability Study in Middle and Higher Income Groups. JAPI. 2010;58.
Issa B, Baiyewu O. Quality of life in patients of diabetes mellitus in a Nigerian teaching hospital. Hong Kong J psychiatry. 2006;16:27-33.
Fal AM, Jankowska B, Uchmanowicz I, Sen M, Panaszek B, Polanski J. Type 2 diabetes quality of life patients treated with insulin and oral hypoglycemic medication. Acta Diabetol. 2011;48(3):237-42.
Chaudhry R, Mishra P, Mishra J, Parminder S, Mishra BP. Psychiatric morbidities among diabetic patients: A hospital based study. Industrial psychiatry journal. 2010;19(1):47-9.
Kruse J, Schmitz N, Thefeld W. On the association between diabetes and mental disorders in a community sample: results from the German National Health Interview and Examination Survey. Diabetes Care. 2003;26:1841-6.
Gautam Y, Sharma AK, Agarwal AK, Bhatnagar MK, Trehan RR. A cross-sectional study of QOL of diabetic patients at tertiary care hospitals in Delhi. Indian J Community Med. 2009;34:346-50.
Huang MF, Courtney M., Edwards H, McDowell J. Factors that affect health outcomes in adults with type 2 diabetes: A cross-sectional study. Int J Nurs Stud. 2010;47:542-9.
Kapur A, Shishoo S, Ahuja MMS, Vidyasen, Mankame K. Diabetes Care in India. Patient’s Perceptions, Attitudes and Practices. Int J Diabetes Dev Ctries. 1997;17:5-14.
Garratt M, Schmidt L, Fitzpatrick R. Patient-assessed health outcome measures for diabetes: a structured review. Diabetes UK. Diabetic Medicine. 2002;19:1-11.
Mudaliar S, Edelman SV. Insulin therapy in type-2 diabetes. Endocrinology and Metabolism Clinics. 2001;30(4):1-32.
Davis TM, Clifford RM, Davis WA. Effect of insulin therapy on quality of life in Type 2 diabetes mellitus: the fremantle diabetes study. Diabetes Res Clin Pract. 2001;52(1):63-71.
Mori Y. Exploring an optimal approach to the use of oral hypoglycemic agents based on CGM results: implications for combination therapy with oral hypoglycemic agents. Nihon Rinsho. 2011;69(8):1505-14.
Klein BE, Klein R, Moss SE. Self-rated health and diabetes of long duration. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Diabetes Care. 1998;21:236-40.
Blonde L, Dey J. Linking improved glycemic control, quality of life, and economics: evidence to support intuition. Clinical Diabetes.1999;17(4):180.
Holmes J, McGill S, Kind P, Bottomley J, Gillam S, Murphy M. Health-related quality of life in type 2 diabetes (T2ARDIS-2). Value Health. 2000;3 (Suppl 1):547-51.
Grant J, Hicks N, Taylor AW, Chittleborough CR, Phillips PJ. Gender-specific epidemiology of diabetes: a representative cross-sectional study. The North West Adelaide Health Study Team. Int J Equity Health. 2009;8:6.
Jacobson AM, Groot MD, Samson JA. The effects of psychiatric disorders and symptoms on quality of life in patients with type i and type ii diabetes mellitus. Qual Life Res. 1997;6(1):11-20.
Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Smith DG. Risk factors for diabetic peripheral sensory neuropathy. Results of Seattle Prospective Diabetic Foot study. Diabetes care.1997;20:1162-7.
Spangler JG, Konen JC, McGann KP. Prevalence and predictors of problem drinking among primary care diabetic patients. Journal of family practice. 1993;37:370-5.
Ismail K, Peveler R. Diabetes, In Handbook of Liaison Psychiatry. Llyod G, Guthrie E, eds. Cambridge university press. 2007;1:454-73.