Glycemic control and quality of life in diabetes mellitus

Purpose This study sought to evaluate the association between quality of life (QOL) and changes in hemoglobin A1c (HbA1c) levels in diabetic patients over a 1-year period. Methods Diabetic patients were identified from clinic databases using International Classification of Diseases (ICD-9) codes. Patients were asked to complete Short Form 36 (SF-36), which measures health-related QOL, and were invited to attend monthly diabetes education workshops. From December 2000 to December 2001, data were collected on multiple parameters, including HbA1c. SF-36 surveys were again collected at project termination. Regression analysis was used to correlate change in HbA1c with change in QOL scores while controlling for potential confounders. Results Of 1679 eligible patients identified, 380 completed SF-36 at project initiation; 243 of those also completed SF-36 at project termination. Pre- and postproject HbA1c data were available for 170 of the 243 patients who completed SF-36 at both time points. After adjusting for baseline SF-36 scores and changes in SF-36ʹs physical component scores, a 5% decrease in HbA1c values was associated with a 1% increase in mental component scores of SF-36. No association between changes in HbA1c levels and physical QOL scores was observed. Conclusion The association between better HbA1c levels and improved mental, but not physical, QOL may reflect physical inconvenience associated with increased regimen complexity as well as mental empowerment from proactive disease management. Large experimental studies are needed to elucidate the long-term relationship between glycemic control and QOL before clinical recommendations can be made.