Step-ups in Type 2 diabetes treatment unrelated to QOL

Concerns about quality of life and health status should not delay or prevent treatment intensification in people with type 2 diabetes, according to findings from the Fremantle Diabetes Study Phase ll.

The study of 930 participants assessed at baseline and at two subsequent biennial reviews found no difference in health status or quality of life measures associated with step-ups in treatment.

However both the physical and mental health components of the Short Form-12 version 2 (SF-12v2) and the Audit of Diabetes Dependent QoL 19 (ADDQoL) scores were lowest in the patients on stable insulin therapy.

During the study period, most patients (42%) were stable on oral glucose-lowering medications, on diet (17.2%) or on insulin (18.1%). About 9% of patients intensified from diet to oral medications and a similar number from oral medications only to insulin.

Researcher Professor Tim Davis from the University of Western Australia Medical School at Fremantle Hospital, told the limbic the evidence in the literature was inconsistent.

“Treatment intensification, especially the introduction of insulin either reduces quality of life because it is a new intrusive therapy or indeed improves quality of life because it restores better glucose levels.”

“We found that it had very little effect on quality of life and that it was really the disease burden and in particular, long duration of diabetes with complications, that [had] the most pronounced adverse effect on health status and quality of life.”

Prof Davis said the findings should be reassuring to both patients and prescribers.

“We are always worried that the things we do for patients might have bad effects on their enjoyment of life. I think we can be reassured that in most patients that we studied, there was no issue with quality of life when either their tablets were increased or they were started on insulin.”

“And that’s good because obviously there is a therapeutic need and type 2 diabetes is a progressive disease requiring more intensive treatment as time goes on.”

He added that a lot of the patients with relatively low quality of life who were already on insulin in the study had started to develop complications including heart disease, kidney problems, foot disease and visual impairment.

“Quality of life is really determined by the disease itself and not its treatment and clearly avoiding complications is a good thing.”

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