Good continuity of care may improve quality of life in Type 2 diabetes

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Abstract

Some features of diabetes care and diabetes treatment regimen which may have an impact on health-related quality of life (HRQOL) in people with diabetes were studied cross-sectionally using the SF-20 questionnaire. Of the 381 subjects with Type 2 diabetes aged under 65 years, 260 (68%) participated in the study. On univariate analysis, HRQOL was associated with regular clinical review (check-up at least twice a year) and continuity of care (the same GP for at least 2 years), education by a diabetes nurse, and satisfaction with diabetes education. No associations were found between the HRQOL dimensions and home glucose monitoring, participation in educational courses, or satisfaction with care. On logistic regression analysis only good continuity of care was significantly associated with the better well-being dimensions of the SF 20 (ORs 2.5–6.0). However, good continuity of care was also associated with less satisfactory glucose control (HbA1c 8.9±2.0 (±SD) vs 8.3±2.0%, P=0.04). It is concluded that a permanent physician–patient relationship may improve HRQOL in subjects with Type 2 diabetes, but further prospective studies are needed to confirm this finding.

Introduction

People with chronic diseases, such as Type 2 diabetes, have to face many problems which may have an impact on their health-related quality of life (HRQOL). Chronic diseases are often lifelong with uncertain prognosis and despite continuing treatment may cause symptoms and acute complications. In addition, they are often accompanied by other chronic diseases. These diseases require regular visits to several health care professionals, utilization of the service of clinics and outpatient centres, patient education, and technical devices [1]. Consequently, one of the primary objectives in the treatment of chronic diseases is the improvement of the patient's HRQOL [2].

Routine diabetes care includes regular check-ups by a physician and a diabetes nurse, diabetes education, compliance with diet, exercise, glucose-lowering agents and self blood-glucose monitoring. This process and the physician–patient relationship are of importance for good results. Presumably, regular check-ups and laboratory monitoring, proper diabetes education, and good continuity of care could also improve HRQOL. In previous studies, people with Type 2 diabetes have been reasonably satisfied with their care [3], [4], [5], although the reported clinical and laboratory examination rates have been quite low [5], [6].

There are only a few studies of the impact of the health care system and diabetes care on HRQOL [4], [7], [8], [9]. In a prospective trial of monthly contacts with a diabetes nurse to provide patient education and reinforce compliance, glycaemic control was slightly improved but there was no improvement in HRQOL [7]. In the prospective studies, initiation of insulin therapy in Type 2 diabetic subjects tended to impair HRQOL slightly, while disappearance of hyperglycaemic symptoms improved HRQOL [8], [9]. Regular blood-glucose monitoring at home had no association with good HRQOL [4].

The objective of the present study was to attempt to identify the factors in diabetes care associated with HRQOL.

Section snippets

Materials and methods

The study population consisted of people with Type 2 diabetes aged under 65 years and living in the Mikkeli district (population 53 000) in eastern Finland. The formation of the study population has been discussed in detail previously [5]. HRQOL and the rate of depressive symptoms were assessed with the well-validated Short Form-20 General Health Survey (SF-20) and the Zung Self-Rating Depression Scale [10], [11].

In the Health Centre of Mikkeli, the population was identified from electronic

Results

The study population, and the quality of diabetes care have been discussed elsewhere [5]. The non-responders were more often men (65 vs 54%), had not been diagnosed for diabetes (54 vs 30%), and consequently they had less severe diabetes (50 vs 71% were treated with oral hypoglycaemic agents and/or insulin). Of the diabetic subjects, 62% had good continuity and regularity of care. Eighty-five percent had received education from a diabetes nurse, but only 10% had participated in a diabetes

Discussion

The main result of the present study is that continuity of care seems to be an important factor of good HRQOL in people with Type 2 diabetes. The diabetic subjects who had been treated by the same GP for at least 2 years seemed to have better mental health and less pain and they felt more healthy in themselves than those who did not have a permanent physician–patient relationship.

The present cross-sectional study cannot reveal causal relationships, and the results should be interpreted with

Acknowledgements

We thank Ulla Rajala for help in regression modelling and ADP designer Paavo Mäkinen for help with the statistical analyses.

References (18)

  • J. Hänninen et al.

    Quality of life in NIDDM patients assessed with the SF-20 questionnaire

    Diabetes Res. Clin. Pract.

    (1998)
  • J. Hänninen et al.

    Albuminuria. and other risk factors for mortality in patients with NIDDM aged under 65 years

    Diabetes Res. Clin. Pract.

    (1999)
  • L.A. Strauss et al.
  • K.G.M.M. Alberti et al.

    Management of non-insulin-dependent diabetes mellitus in Europe: a consensus view

    Diabet. Med.

    (1988)
  • M. Kamien et al.

    Type 2 diabetes. Patient practices and satisfaction with GP care

    Aust. Fam. Physician

    (1995)
  • R. Wredling et al.

    Wellbeing and treatment satisfaction in adults with diabetes: a Swedish population-based study

    Qual. Life Res.

    (1995)
  • J. Hänninen et al.

    Population-based audit of noninsulin-dependent diabetic patients aged under 65 years in primary health care

    Scand. J. Prim. Health Care

    (1998)
  • P.E. Wändell et al.

    Diabetic patients in primary health care — quality of care three years apart

    Scand. J. Prim. Health Care

    (1998)
  • M. Weinberger et al.

    A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life

    J. Gen. Int. Med.

    (1995)
There are more references available in the full text version of this article.

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