Abstract
INTRODUCTION:
Diabetes mellitus is a highly prevalent chronic disease. Type 1 diabetes mellitus usually develops during infancy and adolescence and may affect the quality of life of adolescents.
OBJECTIVE:
To evaluate the quality of life of adolescents with type 1 diabetes mellitus in a metropolitan region of western central Brazil.
METHODS:
Adolescents aged 10-19 years who had been diagnosed with type 1 diabetes mellitus at least 1 year previously were included. Patients with verbal communication difficulties, severe disease, and symptomatic hypo- or hyperglycemic crisis as well as those without an adult companion and who were <18 years of age were excluded. The self-administered Diabetes Quality of Life for Youths instrument was applied.
RESULTS:
Among 96 adolescents (57% females; 47% white, and 53% nonwhite), 81% had an HbA1c level of >7%. In general, the adolescents consistently reported having a good quality of life. The median scores for the domains of the instrument were as follows: “satisfaction”: 35; “impact”: 51; and “worries“: 26. The total score for all domains was 112. Bivariate analysis showed significant associations among a lower family income, public health assistance, and insulin type in the “satisfaction” domain; and a lower family income, public health assistance, public school attendance, and a low parental education level in the “worries“ domain and for the total score. A longer time since diagnosis was associated with a lower total score. Multivariable analysis confirmed the association of a worse quality of life with public health assistance, time since diagnosis, and sedentary lifestyle in the “satisfaction” domain; female gender in the “worries” domain; and public health assistance for the total score.
CONCLUSIONS:
Overall, the adolescents evaluated in this study viewed their quality of life as good. Specific factors that led to the deterioration of quality of life, including public assistance, time since diagnosis, sedentary lifestyle, and female gender, were identified.
No potential conflict of interest was reported.
Quality of Life; Type 1 Diabetes; Adolescent
INTRODUCTION
Diabetes mellitus (DM) is a highly prevalent chronic disease and an important public
health problem (11 International Diabetes Federation, 2013 Sixth edition, 2013.
Available at: www.idf.org/diabetesatlas.. (Acessed on Mar 28,
2014).
www.idf.org/diabetesatlas....
,22 World Health Organization - Diabetes Progamme - Avaiable at:
http://www.who.int/diabetes/en/. (Acessed on Jun 20, 2014).
http://www.who.int/diabetes/en/....
). Currently, an estimated 382 million people have diabetes
worldwide, and this number is predicted to rise to 592 million by the year 2035.
Approximately 80% of diabetics live in developing countries, where rapid lifestyle
changes, the aging of the population, and environmental changes have contributed to
a significant increase in DM incidence. In 2013, expenditures of $548 billion
were associated with this disease, accounting for 11% of total global healthcare
costs (11 International Diabetes Federation, 2013 Sixth edition, 2013.
Available at: www.idf.org/diabetesatlas.. (Acessed on Mar 28,
2014).
www.idf.org/diabetesatlas....
).
In Brazil, epidemiological data on diabetes are scarce. Some studies have indicated a
prevalence of 7.6-13.5% (33 Malerbi DA, Franco LJ. Multicenter study of the prevalence of
diabetes mellitus and impaired glucose tolerance in the urban Brazilian
population aged 30-69 years. Brazilian Cooperative Group on the Study of
Diabetes Prevalence. Diabetes Care. 1992;15(11):1509-16.,44 Bosi PL, Carvalho AM, Contrera D, Casale G, Pereira MA, Gronner
M, et al. Prevalência de diabete melito e tolerância è glicose
diminuída na população urbana de 30 a 79 anos da cidade de
São Carlos, São Paulo. Arq Bras Endocrinol Metab. 2009;53(6):726-32,
http://dx.doi.org/10.1590/S0004-27302009000600006.
http://dx.doi.org/10.1590/S0004-27302009...
). It has been estimated that by 2030, Brazil
will advance from the eighth to the sixth position in terms of the worldwide
prevalence of diabetes due to an increase from 4.6 to 11.3% (55 Brasil. Ministério da Saúde. Secretaria de
Atenção Saúde. Departamento de Atenção Básica.
Strategies for the care of the person with chronic disease: Diabetes Mellitus.
Caderno de Atenção Básica n 36 - Brasília - 2013.
Avaliable at:
http://189.28.128.100/dab/docs/portaldab/publicacoes/caderno_36.pdf
(Acessed on jun 20, 2014).
http://189.28.128.100/dab/docs/portaldab...
).
Type 1 diabetes mellitus (T1DM) usually develops during infancy and adolescence and
results from the progressive destruction of pancreatic beta cells and reduced
insulin production (66 American Diabetes Association. Diagnosis and Classification
of Diabetes Mellitus. Diabetes Care. 2014;37 Suppl 1:S81-90,
http://dx.doi.org/10.2337/dc14-S081.
http://dx.doi.org/10.2337/dc14-S081...
). The prevalence of
T1DM varies between 0.05% and 0.3% in children <15 years of age in most
European and North American populations (11 International Diabetes Federation, 2013 Sixth edition, 2013.
Available at: www.idf.org/diabetesatlas.. (Acessed on Mar 28,
2014).
www.idf.org/diabetesatlas....
,77 Pettitt DJ, Talton J, Dabelea D, Divers J, Imperatore G, Lawrence
JM, et al. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes
in youth study. Diabetes Care. 2014;37(2):402-8,
http://dx.doi.org/10.2337/dc13-1838.
http://dx.doi.org/10.2337/dc13-1838...
). A prevalence of 0.2% has
been estimated for the same age group in Brazil (88 Sociedade Brasileira de Diabetes. Atualização
brasileira sobre diabetes. Rio de Janeiro: Diagraphic; 2006. Avaiable at:
http://ibras.net/Arquivoscientificos/SistemaEndocrino2/Diabetesmellitustipo2.pdf
(Acessed on Jun 20, 2014).
http://ibras.net/Arquivoscientificos/Sis...
), and recent data have demonstrated an increasing incidence that is
similar to those of European countries (99 Patterson NCC, Dahlquist GG, Gyurus E Green A, Soltész G,
EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe
during 1989-2003 and predicted new cases 2005-20: a multicentre prospective
registration study. Lancet. 2009;373(9680):2027-33,
http://dx.doi.org/10.1016/S0140-6736(09)60568-7.
http://dx.doi.org/10.1016/S0140-6736(09)...
).
T1DM and its complications may affect adolescents' living conditions over the
years and may also influence their quality of life (QOL) (1010 Sawyer MG, Reynolds KE, Couper JJ, French DJ, Kennedy D, Martin
J, Staugas R, et al. Health-related quality of life of children and adolescents
with chronic illness - a two year prospective study. Qual Life Res.
2004;13(7):1309-19,
http://dx.doi.org/10.1023/B:QURE.0000037489.41344.b2.
http://dx.doi.org/10.1023/B:QURE.0000037...
). Hormonal alterations, immaturity, difficulties in
acquiring autonomous control, and a low rate of disease acceptance may hinder the
daily control of blood glucose levels. In general, adolescents are more resistant to
accepting the disease than younger children because they no longer depend on their
parents or guardians for care and are responsible for their own health. Psychosocial
issues (1111 Coates VE, Boore JR. The influence of psychological factors on
the self-management of insulin-dependent diabetes mellitus. J Adv Nurs.
1998;27(3):528-37,
http://dx.doi.org/10.1046/j.1365-2648.1998.00546.x.
http://dx.doi.org/10.1046/j.1365-2648.19...
) also influence the behavior of
adolescents, reflecting their attitudes toward diabetes.
The present study aimed to evaluate the Health-Related Quality of Life (HRQOL) in adolescents with T1DM from the metropolitan region of Cuiabá, Brazil to understand the different aspects associated with the health-disease process and the impact of this condition on daily activities. The HRQOL (1212 da Mota Falcão D, Ciconelli RM, Ferraz MB. Translation and cultural adaptation of quality of life questionnaires: an evaluation of methodology. J Rheumatol. 2003;30(2):379-85.) is evaluated using measuring instruments that transform subjective and individual concepts into objective and measurable data.
The results of this study may contribute to changes in professional practice as well as to health policies. These actions may result in the improvement of service delivery to adolescents with T1DM by taking into account these patients' experiences beyond the biological model.
METHODS
A cross-sectional study of adolescents with T1DM assisted from March 2012 to February 2014 was performed at the outpatient endocrinology clinics of the Júlio Müller University Hospital and the General Hospital of the University of Cuiabá, both of which are reference/public services for treating children and adolescents with DM of the Medical Specialties Centers of Cuiabá and Várzea Grande and of private endocrinologists in the metropolitan region of Cuiabá. This case study included patients assisted by the public health system and private health insurance plans.
The adolescents included in the study ranged in age from 10 to 19 years (according to the World Health Organization [WHO] definition) and had been diagnosed with T1DM more than 1 year previously. Patients with verbal communication difficulties, severe disease, and symptomatic hypo- or hyperglycemic crisis as well as those under 18 years of age without an adult companion were excluded.
The required sample size of 95 adolescents was obtained with a confidence interval of
95% and a sampling error of 0.009, taking into account the population of adolescents
in the state of Mato Grosso (1313 IBGE: Instituto Brasileiro de Geografia e Estatística 2010.
Demographic Census. Avaliable at:
www.ibge.gov.br/estadosat/perfil.php?sigla = mt. (acessed on
Apr 23, 2011).
www.ibge.gov.br/estadosat/perfil.php?sig...
) and the T1DM
prevalence of 0.2% (88 Sociedade Brasileira de Diabetes. Atualização
brasileira sobre diabetes. Rio de Janeiro: Diagraphic; 2006. Avaiable at:
http://ibras.net/Arquivoscientificos/SistemaEndocrino2/Diabetesmellitustipo2.pdf
(Acessed on Jun 20, 2014).
http://ibras.net/Arquivoscientificos/Sis...
) in the country.
Demographic, socio-economic, and clinical data were obtained by interviews and a
standardized questionnaire. The patients' weights, heights, and exam results
were collected from their medical records. The body mass indices (BMIs) and
classifications of the nutritional states of the participants were obtained using
WHO AnthroPlus software (1414 WHO AnthroPlus 1.0.4.WHO, 2007. Avaiable at:
http://www.who.int/growthref/tools/en/. Acessed on Mar 15,
2014.
http://www.who.int/growthref/tools/en/....
). The
participants reported their race according to the Brazilian Institute of Geographic
and Statistics classification system (1313 IBGE: Instituto Brasileiro de Geografia e Estatística 2010.
Demographic Census. Avaliable at:
www.ibge.gov.br/estadosat/perfil.php?sigla = mt. (acessed on
Apr 23, 2011).
www.ibge.gov.br/estadosat/perfil.php?sig...
) as
white, brown, black, indigenous or yellow. For comparative analyses, the different
races were divided in two groups (white and nonwhite) because of the small numbers
of black and yellow people in this population.
To collect data regarding QOL, we used the instrument Diabetes Quality of Life for
Youths (DQOLY), which is a specific instrument to evaluate the QOL of adolescents
with diabetes (1515 Ingersoll GM, Marrero DG. A modified quality-of-life measure for
youths: psychometric properties. Diabetes Educ. 1991;17(2):114-8,
http://dx.doi.org/10.1177/014572179101700219.
http://dx.doi.org/10.1177/01457217910170...
). The DQOLY was adapted and
validated for the Portuguese language and for Brazilian culture (1616 Novato TS, Grossi SA, Kimura M. Cultural adaptation and
validation of the “Diabetes Quality for Youths” measure of
Ingersoll and Marrero into Brazilian Culture. Rev Lat Am Enfermagem.
2008;16(2):224-30,
http://dx.doi.org/10.1590/S0104-11692008000200009.
http://dx.doi.org/10.1590/S0104-11692008...
). This instrument evaluates the domains of
satisfaction (17 items), impact (22 items), and worries (11 items). Responses are
given on a Likert scale. Each question is answered using a scale ranging from 1 to 5
(very satisfied to very unsatisfied, respectively, for the satisfaction domain and
never to always for the worries and impact domains). The total score is the sum of
the domain scores. There is no cutoff score for this instrument; thus, the lowest
value corresponds to a better QOL. In addition to the DQOLY items, the participants
were asked to self-evaluate the state of their health compared with the states of
health of other young people from the same age group. The responses included the
following four options: 1 = excellent; 2 = good; 3
= satisfactory; and 4 = bad. This question has been
used together with the DQOLY internationally (1515 Ingersoll GM, Marrero DG. A modified quality-of-life measure for
youths: psychometric properties. Diabetes Educ. 1991;17(2):114-8,
http://dx.doi.org/10.1177/014572179101700219.
http://dx.doi.org/10.1177/01457217910170...
,1717 Faulkner MS, Chang LI. Family influence on self-care, quality of
life, and metabolic control in school-age children and adolescents with type 1
diabetes. J Pediatr Nurs. 2007;22(1): 59-68,
http://dx.doi.org/10.1016/j.pedn.2006.02.008.
http://dx.doi.org/10.1016/j.pedn.2006.02...
).
All data were collected by the author LMFCC. Interviews were performed to present the DQOLY for its self-administration. The adolescents were interviewed as outpatients and in private medical offices during routine health-care visits. The interviews were pre-scheduled by telephone and were conducted at home. The adolescents were instructed to respond to the instrument autonomously. The researcher was available to read and clarify questions for those adolescents ≤ 14 years of age because of their potential difficulties with understanding some of them.
The collected data were entered twice to minimize processing mistakes. Statistical analysis was performed using the Stata V13.0 software (StataCorp, College Station, TX) (1818 STATA Corp LP. Stata Statistical Software: Release 13.0. Stata corporation: College Station, Texas; 2014. TX USA.). The prevalence ratios and their 95% confidence intervals were calculated using Pearson's chi square test to analyze the association between the scores above and below the median and between the demographic and clinical variables. This test was also used for bivariate analysis of the association between health status and the studied variables. A 5% significance level was adopted. Multivariate analysis was performed using the Poisson multiple regression model. This model included the variables with a significance level of greater than 20% (p> 0.20), as shown by bivariate analysis. A significance level of 5% and a 95% confidence interval were adopted for the final regression model.
ETHICS
All included patients or their guardians for those under 18 years of age were sufficiently informed about this study. The patients and guardians signed informed consent forms. The Research Ethics Committee of the Faculty of Medicine of the University of São Paulo approved this study.
RESULTS
Ninety-nine adolescents were included in this study. Three adolescents were excluded because they refused to participate. The socio-demographic and clinical characteristics of the 96 analyzed adolescents are shown in Table 1. Before being divided into two large groups (white and nonwhite), 45 adolescents reported being of white color, 46 of brown color, 4 of black color, and 1 of yellow color. The mean value of the last glycated hemoglobin (HbA1c) level was 9.59% ± 2.82%. The mean BMI was 20.01 ± 3.09 kg/m2.
Analysis of the DQOLY scores showed a normal distribution (Shapiro test p> 0.10), which allowed for a comparison of the percentages of scores above/equal to the median with those below the median for each domain. The median (minimum-maximum) total DQOLY score and domain scores were as follows: total DQOLY value, 111 (59-165); satisfaction, 35 (17-62); impact, 50 (26-73); and worries, 26 (11-44). The distribution of percentages of scores above and below the median according to the domain and bivariate analyses are shown in Tables 2A, 2B, 3A and 3B. The variables with a p <0.20 were selected for analyses using logistic regression models, as shown in Table 4.
Bivariate analysis of associations between clinical characteristics and the domains “Satisfaction” and “Impact”.
Bivariate analysis of associations between clinical characteristics and the domain “Worries” and the total score.
In response to the specific question regarding their perception of their own health, 29% reported it as excellent, 48% as good, 17% as satisfactory, and 6% as bad. Participants who were only students and those who frequently participated in physical activities were more likely to declare their health state as excellent or good compared with those who were students with sedentary habits (prevalence ratio [PR] = 2.53; p = 0.046). The association between the best declared health state and being a student who exercised regularly remained significant after adjusting for family income, type of insulin, the self-monitoring of blood glucose, the time since the last HbA1c measurement, the frequency of exercise, and the nutritional status (PR = 2.54; p = 0.011).
DISCUSSION
The assisted adolescents with T1DM from the metropolitan region of Cuiabá were
mostly female and reported similar proportions of white and nonwhite races,
corresponding with the demographic characteristics of the region (1313 IBGE: Instituto Brasileiro de Geografia e Estatística 2010.
Demographic Census. Avaliable at:
www.ibge.gov.br/estadosat/perfil.php?sigla = mt. (acessed on
Apr 23, 2011).
www.ibge.gov.br/estadosat/perfil.php?sig...
). The active search for cases included
regional hospitals and private practices to ensure for the inclusion of a
representative sample of adolescents that was independent of socioeconomic class and
that allowed for a comparison of the HRQOL according to this specific parameter.
Only adolescents with chronic disease were included in the study (i.e., with a diagnosis given more than 1 year ago) to avoid possible fluctuations in the evaluation during the adaptation and remission periods, which are common during the first year of the disease. Most of the studied adolescents had been diagnosed >3 years previously and received more than three daily injections of insulin. The evaluation of treatment parameters and disease control revealed that although the patients were under clinical supervision (with the self-monitoring of blood glucose and controlling of HbA1c in the past months), they did not have ideal control of their DM. Most had at least one episode of hypo- or hyperglycemia in the past month (93%), and more than one half (67%) reported a previous hospitalization due to DM. In addition, the mean value for metabolic control, as evaluated by HbA1c measurements, was 9.6%, confirming the absence of good control of the disease in these patients.
Despite signs of uncontrolled chronic disease, most of the evaluation results were
consistent with a good perception of the health state by the adolescents. A likely
explanation is that these patients were still in the initial phase of this chronic
disease, which does not yet involve any irreversible repercussions, and they were
young (mean age of 14 years), which contributed to more favorable evaluations of
their health. A recent systematic (1919 Nieuwesteeg A, Pouwer F, van der Kamp R, van Bakel H, Aanstoot
HJ, Hartman E. Quality of life of children with type 1 diabetes: a systematic
review. Curr Diabetes Rev. 2012;8(6):434-43,
http://dx.doi.org/10.2174/157339912803529850.
http://dx.doi.org/10.2174/15733991280352...
) review
has also noted the similarities in the QOL reported by young people with and without
diabetes; however, the affected individuals observed specific impacts of the disease
in their daily lives.
Metabolic control has been a target of the treatment DM to ensure for not only the
improved organic evolution of the disease but also a better QOL. A trend of the
deterioration of metabolic control in adolescents is due to hormonal alterations in
addition to psychological and behavioral aspects (2020 Court JM, Cameron FJ, Berg-Kelly K, Swift PGF. Diabetes in
adolescence. Pediatric Diabetes. 2009:10(Suppl. 12):185-94,
http://dx.doi.org/10.1111/j.1399-5448.2009.00586.x.
http://dx.doi.org/10.1111/j.1399-5448.20...
) that are characteristic of this phase of life. A recent cohort study
(2121 Lawrence JM, Yi-Frazier JP, Black MH, Anderson A, Hood K,
Imperatore G, et al. Demographic and clinical correlates of the diabetes-related
quality of life among youth with type 1 Diabetes. J Pediatr.
2012;161(2):201-7.e2,
http://dx.doi.org/10.1016/j.jpeds.2012.01.016.
http://dx.doi.org/10.1016/j.jpeds.2012.0...
) of 2,602 diabetic patients with a
mean age of 13 years has found that poor metabolic control, as assessed by
HbA1c measurements, is associated with worse QOL. However, other
studies (1515 Ingersoll GM, Marrero DG. A modified quality-of-life measure for
youths: psychometric properties. Diabetes Educ. 1991;17(2):114-8,
http://dx.doi.org/10.1177/014572179101700219.
http://dx.doi.org/10.1177/01457217910170...
,1717 Faulkner MS, Chang LI. Family influence on self-care, quality of
life, and metabolic control in school-age children and adolescents with type 1
diabetes. J Pediatr Nurs. 2007;22(1): 59-68,
http://dx.doi.org/10.1016/j.pedn.2006.02.008.
http://dx.doi.org/10.1016/j.pedn.2006.02...
) either have not found an association between HbA1c and
QOL or have detected a negative association.
In the present study, the adolescents with longer-established DM diagnoses had a
worse HRQOL. The correlation of the lower satisfaction of the adolescents with a
longer time since diagnosis suggests that the course of the disease is an important
factor in the deterioration of QOL. Multivariable-adjusted analysis of select
treatment characteristics, such as the type of insulin used and the time since the
last laboratory evaluation, showed that the lower satisfaction of these adolescents
was independent of these variables, suggesting a more global influence of the
evolution of the disease on daily activities. The higher awareness of the
adolescents about the chronicity of DM as well as of their real daily needs may have
impacted their satisfaction regarding their HRQOL. However, other studies (2222 Stahl A, Straßburger, Lange KS, traßburger K, Lange K,
Bächle C, Holl RW, et al. Health-related quality of life among German
youths with early-onset and long-duration Type 1 Diabetes. Diabetes Care.
2012;35(8):1736-42, http://dx.doi.org/10.2337/dc11-2438.
http://dx.doi.org/10.2337/dc11-2438...
) using different methods of monitoring have
indicated that the time since diagnosis may have a lesser impact. Stahl et al. did
not identify alterations in QOL in diabetic adolescents with at least 7 years since
diagnosis compared with non-diabetic controls. A cohort study (2121 Lawrence JM, Yi-Frazier JP, Black MH, Anderson A, Hood K,
Imperatore G, et al. Demographic and clinical correlates of the diabetes-related
quality of life among youth with type 1 Diabetes. J Pediatr.
2012;161(2):201-7.e2,
http://dx.doi.org/10.1016/j.jpeds.2012.01.016.
http://dx.doi.org/10.1016/j.jpeds.2012.0...
) also did not detect an influence of the time since
diagnosis on the QOL of adolescents.
A predominant factor influencing the deterioration of QOL identified in the present
study was public service assistance. Although most of the adolescents, even those
being monitored by private clinics, obtained their medication through public service
assistance, the results suggested that the quality of this assistance was
unsatisfactory. These findings may have been due to factors that were not evaluated
in this study, such as the time required to schedule medical appointments, the
emergency services available, and the individualization and broadening of mental
health services and services integrated with the sociocultural characteristics of
the communities where these adolescents live. Therefore, services to diabetic
adolescents are improved if they are organized in a multidisciplinary manner.
Lawrence et al. have also reported that the type of service used by patients
influences QOL. American adolescents receiving Medicare and Medicaid services have
reported a worse QOL compared with those assisted through private services (2121 Lawrence JM, Yi-Frazier JP, Black MH, Anderson A, Hood K,
Imperatore G, et al. Demographic and clinical correlates of the diabetes-related
quality of life among youth with type 1 Diabetes. J Pediatr.
2012;161(2):201-7.e2,
http://dx.doi.org/10.1016/j.jpeds.2012.01.016.
http://dx.doi.org/10.1016/j.jpeds.2012.0...
).
The lower education levels of parents as well as female gender directly reflected a
worse QOL as measured by the DQOLY worries domain. This domain addresses the
concerns of adolescents regarding not only their health and appearance but also
their future and expectations from affective relationships. The lower education
levels of parents, which indicate a lower socioeconomic status, may be associated
with the insecurity of adolescents due to a lack of information and the anticipation
of socioeconomic difficulties in the future. The association between the lower
education levels of parents and the deterioration of the QOL of diabetic children
has been a recurrent theme in the literature (2121 Lawrence JM, Yi-Frazier JP, Black MH, Anderson A, Hood K,
Imperatore G, et al. Demographic and clinical correlates of the diabetes-related
quality of life among youth with type 1 Diabetes. J Pediatr.
2012;161(2):201-7.e2,
http://dx.doi.org/10.1016/j.jpeds.2012.01.016.
http://dx.doi.org/10.1016/j.jpeds.2012.0...
,2323 Hassan K, Loar R, Anderson BJ, Heptulla RA. The role of
socioeconomic status, depression, quality of life, and glycemic control in type
1 diabetes mellitus. J Pediatr. 2006;149(4):526-31,
http://dx.doi.org/10.1016/j.jpeds.2006.05.039.
http://dx.doi.org/10.1016/j.jpeds.2006.0...
).
Physical activity is an important factor in the evaluation of QOL along with the health state of adolescents. A clinical trial (2424 D'hooge R, Hellinckx T, Van Laethem C, Stegen S, De Schepper J, Van Aken S, et al. Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial. Clin Reabil 2011;25(4):349-59.) evaluating young patients with diabetes randomized these subjects into either physical activity or no physical activity groups and found an improvement in the clinical control of disease and QOL in the physical activity group.
To the best of our knowledge, the present study is the first to evaluate HRQOL in diabetic adolescents living in the metropolitan region of Cuiabá. By applying the DQOLY, it was possible to identify the influences of social aspects, such as the type of medical services used and the education levels of parents, on the self-evaluation of QOL. The impacts of characteristic factors of the disease, such as evolution time and exercise, on QOL were also identified. A limitation of this study is its cross-sectional design, which made it impossible to establish causal links. Another limitation is the absence of a control group. However, the results may contribute to new treatment evaluation and monitoring procedures for adolescents with diabetes and possibly to the broadening of multidisciplinary approaches in the face of this complex and chronic disease, which originates during infancy and adolescence.
ACKNOWLEDGMENTS
This study was supported by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).
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» http://dx.doi.org/10.2337/dc14-S081 -
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» http://dx.doi.org/10.2337/dc13-1838 -
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Erratum
In the article Quality of life of adolescents with type 1 diabetes published in Clinics, 70(3):173-9, on page 173, abstract, Line 15, where it reads“lower”it should read“worse”In the same article, on page 174:Table 1, Line 28: where it reads “R” it should read “S”.Table 1, Line 42: where it reads “30.21” it should read “69.79”.Table 1, Line 44: where it reads “69.79” it should read“30.21”.Table 1, Line 45: where it reads “71.88” it should read “28.13”.Table 1, Line 46: where it reads “28.13” it should read “71.88”.In the same article, on page 177, Table 3A should read as:Replace Table 3A for:Characteristic Satisfaction Impact Above median Below median PR IC 95% P Above median Below median PR IC 95% p n % n % n % n % Time with DM ≥ 3 years 32 54.24 27 45.76 1.67 [1.01 ; 2.81] 0.037 30 50.85 29 49.15 1.25 [0.79 ; 2.00] 0.325 1 a < 3 years 12 32.43 25 67.57 1.00 15 40.54 22 59.46 1.00 Insulin/day ≥ 3 injections 30 50.00 30 50.00 1.25 [0.78 ; 2.02] 0.346 30 50.00 30 50.00 1.17 [0.74 ; 1.85] 0.501 ≤ 2 injections 14 40.00 21 60.00 1.00 15 42.86 20 57.14 1.00 Type of insulin UR 0 0.00 7 100.0 0.00 - 0.004 3 42.86 4 57.14 0.94 [0.38 ; 2.31] 1.00 I/I+R/I+UR 16 55.17 13 44.83 1.16 [0.76 ; 1.79] 0.494 16 55.17 13 44.83 1.21 [0.78 ; 1.87] 0.402 S+R/S+UR 27 47.37 30 52.63 1.00 26 45.61 31 54.39 1.00 Self-monitoring of glycaemia No 3 50.00 3 50.00 1.10 [0.48 ; 2.52] 1.00 42 46.67 48 53.33 Yes 41 45.56 49 54.44 1.00 3 50.00 3 50.00 1.07 [0.47 ; 2.46] 1.00 Hipoglycaemia Yes 32 45.07 39 54.93 0.94 [0.58 ; 1.52] 0.800 35 49.30 36 50.70 1.23 [0.72 ; 2.10] 0.423 No 12 48.00 13 52.00 1.00 10 40.00 15 60.00 1.00 Hipo or hiper Yes 42 45.16 51 54.84 0.68 [0.30 ; 1.56] 0.592* 44 47.31 49 52.69 1.42 [0.28 ; 7.13] 1.00 No 2 66.67 1 33.33 1.00 1 33.33 2 66.67 1.00 Last HbA1c ≥ 6 months 10 62.50 6 37.50 1.53 [0.93 ; 2.52] 0.125 7 43.75 9 56.25 0.98 [0.52 ; 1.85] 0.961 3 a < 6 months 12 46.15 14 53.85 1.13 [0.67 ; 1.92] 0.646 14 53.85 12 46.15 1.21 [0.76 ; 1.93] 0.430 < 3 months 22 40.74 32 59.26 1.00 24 44.44 30 55.56 1.00 Physical activity Yes 37 43.02 49 56.98 1.00 40 46.51 46 53.49 1.00 No 7 70.00 3 30.00 1.63 [1.01 ; 2.61] 0.178* 5 50.00 5 50.00 1.08 [0.56 ; 2.08] 1.00 Physical Activity Never 7 70.00 3 30.00 1.65 [0.99 ; 2.70] 0.172* 5 50.00 5 50.00 1.06 [0.54 ; 2.08] 1.00* ≤ 2 times / week 9 45.00 11 55.00 1.06 [0.61 ; 1.86] 0.838 9 45.00 11 55.00 0.96 [0.55 ; 1.66] 0.877 ≥ 3 times/ week 28 42.42 38 57.58 1.00 31 46.97 35 53.03 1.00 Nutritional Status Thinness 3 75.00 1 25.00 1.69 [0.91 ; 3.14] 0.328* 2 50.00 2 50.00 1.16 [0.42 ; 3.20] 1.00 Eutrofic 35 44.30 44 55.70 1.00 34 43.04 45 56.96 1.00 Overweight 6 46.15 7 53.85 1.04 [0.55 ; 1.97] 0.901 9 69.23 4 30.77 1.61 [0.98 ; 2.50] 0.079 Value last Hb1Ac > 7 % 39 50.00 39 50.00 1.80 [0.83 ; 3.92] 0.088 39 50.00 39 50.00 1.50 [0.75 ; 2.99] 0.202 ≤ 7% 5 27.78 13 72.22 1.00 6 33.33 12 66.67 1.00
n the same article, on page 179:Table 4, Line 5: where it reads “> 3 years” it should read “≥ 3 years”.Table 4, Line 6: where it reads “1 - 3 years” it should read “1 at < 3 years”.
Publication Dates
-
Publication in this collection
Mar 2015
History
-
Received
23 Aug 2014 -
Reviewed
19 Nov 2014 -
Accepted
5 Jan 2015