Quality of Life in Type 2 Diabetes Mellitus Patients Requiring Insulin Treatment in Buenos Aires, Argentina: A Cross-Sectional Study

Document Type: Original Article


1 Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina

2 School of Public Health, University of Buenos Aires, Buenos Aires, Argentina

3 Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

4 Family and Community Medicine Division Hospital Italiano de Buenos Aires, Buenos Aires, Argentina


Decision-makers have begun to recognize Health-Related Quality of Life (HRQoL) as an important and measurable outcome of healthcare interventions; and HRQoL data is increasingly being used by policy-makers to prioritize health resources. Our objective was to measure HRQoL in a group of Type 2 Diabetes Mellitus (T2DM) patients receiving insulin treatment in Buenos Aires, Argentina.
We conducted a cross-sectional study of patients with T2DM over 21 years of age, treated with either Neutral Protamine Hagedorn (NPH) insulin or Insulin Glargine (IG), who had not changed their baseline schedule in the last 6 months. The recruitment was during 2006–7 in nine private diabetes specialists’ offices in Buenos Aires, Argentina. A standardized diabetes-specific HRQoL questionnaire, the Audit of Diabetes Dependent Quality of Life (ADDQoL), was used.
A total of 183 patients were included (93 receiving NPH and 90 receiving IG). The mean QoL score was: 0.98 (SD: 0.89) and the diabetes specific QoL was: -1.49 (SD: 0.90). T2DM had a negative impact on HRQoL with a mean Average Weighted Impact (AWI) score on QoL of -1.77 (SD: 1.58). The greatest negative impact was observed for domains: ‘worries about the future’, ‘freedom to eat’, ‘living conditions’, ‘sex life’, and ‘family life’. The mean AWI score was -1.71 (SD: 1.48) in patients treated with IG and -1.85 (SD: 1.68) in patients receiving NPH, this difference was not statistically significant.
The ADDQoL questionnaire is a tool that can be used in Argentina to measure the QoL of patients with diabetes when evaluating diabetes care programs. The scores of QoL in our selected population did not differ from those reported in high-income countries. We expect that the results of this study will increase healthcare providers’ awareness of patients’ perceived QoL and help to overcome the barriers that delay insulin treatment; mainly clinical inertia and patient resistance.


Main Subjects

  1. Snoek FJ, Skinner TC. Psychology in diabetes care. 2nd ed. Chichester; Hoboken, NJ: Wiley; 2005.
  2. Bradley C, de Pablos-Velasco P, Parhofer KG, Eschwege E, Gonder-Frederick L, Simon D. PANORAMA: a European study to evaluate quality of life and treatment satisfaction in patients with type-2 diabetes mellitus--study design. Prim Care Diabetes 2011; 5: 231-9.  doi: 10.1016/j.pcd.2011.04.004
  3. Koopmanschap M. Coping with Type II diabetes: the patient's perspective. Diabetologia 2002; 45: S18-22.  doi: 10.1007/s00125-002-0861-2
  4. Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev 1999; 15: 205-18.  doi: 10.1002/(SICI)1520-7560(199905/06)15:33.0.CO;2-O
  5. Mata Cases M, Roset Gamisans M, Badia Llach X, Antoñanzas Villar F, Ragel Alcázar J. Impacto de la diabetes Mellitus tipo 2 en la calidad de vida de los pacientes tratados en las consultas de atención primaria en España (Effect of type-2 diabetes mellitus on the quality of life of patients treated at primary care consultations in spain). Aten Primaria 2003; 31: 493-9. 
  6. Jacobson AM. The psychological care of patients with insulin-dependent diabetes mellitus. N Engl J Med 1996; 334: 1249-53.  doi: 10.1056/NEJM199605093341907
  7. Hornquist JO, Wikby A, Stenstrom U, Andersson PO, Akerlind I. Type II diabetes and quality of life: a review of the literature. Pharmacoeconomics 1995; 8 Suppl 1: 12-6. 
  8. Aguiar CC, Vieira AP, Carvalho AF, Montenegro-Junior RM. [Assessment instruments for a Health-Related Quality of Life in diabetes mellitus]. Arq Bras Endocrinol Metabol 2008; 52: 931-9.  [in Portuguese]
  9. Norris SL. Health-related quality of life among adults with diabetes. Curr Diab Rep 2005; 5: 124-30. 
  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.  doi: 10.1002/dmrr.279
  11. Redekop WK, Koopmanschap MA, Stolk RP, Rutten GE, Wolffenbuttel BH, Niessen LW. Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diabetes Care 2002; 25: 458-63. 
  12. Unden AL, Elofsson S, Andreasson A, Hillered E, Eriksson I, Brismar K. Gender differences in self-rated health, quality of life, quality of care, and metabolic control in patients with diabetes. Gend Med 2008; 5: 162-80.  doi: 10.1016/j.genm.2008.05.003
  13. Ferrante D, Linetzky B, Konfino J, King A, Virgolini M, Laspiur S. 2009 national Risk Factors survey: evolution of the epidemic of chronic non communicable diseases in Argentina. Cross sectional study. Rev Argent Salud Pública 2011; 2: 34-41. 
  14. Bradley C, Gilbride CJ. Improving treatment satisfaction and other patient-reported outcomes in people with type 2 diabetes: the role of once-daily insulin glargine. Diabetes Obes Metab 2008; 10 Suppl 2: 50-65.  doi: 10.1111/j.1463-1326.2008.00871.x
  15. Perrotta C, Irazola V. Validación linguistica de un cuestionario específico para medir calidad de vida relacionada con la salud (CVRS) "Audit of life diabetes dependent questionnaire" (ADDQOL) al español como se habla en la Argentina. Rev Soc Arg de Diabetes 2002; 36: 107. 
  16. Bradley C, Todd C, Gorton T, Symonds E, Martin A, Plowright R. The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qual Life Res 1999; 8: 79-91. 
  17. Gagliardino JJ, de la Hera M, Siri F. [Evaluation of the quality of care for diabetic patients in Latin America]. Rev Panam Salud Publica 2001; 10: 309-17. [in Spanish]
  18. Ashwell SG, Bradley C, Stephens JW, Witthaus E, Home PD. Treatment satisfaction and quality of life with insulin glargine plus insulin lispro compared with NPH insulin plus unmodified human insulin in individuals with type 1 diabetes. Diabetes Care 2008; 31: 1112-7.  doi: 10.2337/dc07-1183
  19. DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002; 325: 746. 
  20. Polonsky WH. Emotional and quality-of-life aspects of diabetes management. Curr Diab Rep 2002; 2: 153-9. 
  21. Depablos-Velasco P, Salguero-Chaves E, Mata-Poyo J, Derivas-Otero B, Garcia-Sanchez R, Viguera-Ester P. Quality of life and satisfaction with treatment in subjects with type 2 diabetes: results in Spain of the PANORAMA study. Endocrinol Nutr 2014; 61: 18-26.  doi: 10.1016/j.endonu.2013.05.005
  22. Hajos TR, Pouwer F, de Grooth R, Holleman F, Twisk JW, Diamant M, et al. The longitudinal association between glycaemic control and health-related quality of life following insulin therapy optimisation in type 2 diabetes patients. A prospective observational study in secondary care. Qual Life Res 2012; 21: 1359-65.  doi: 10.1007/s11136-011-0051-0
  23. Weinberger M, Kirkman MS, Samsa GP, Cowper PA, Shortliffe EA, Simel DL, et al. The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus. Med Care 1994; 32: 1173-81. 
  24. Kuznetsov L, Long GH, Griffin SJ, Simmons RK. Are changes in glycaemic control associated with diabetes-specific quality of life and health status in screen-detected type 2 diabetes patients? Four-year follow up of the ADDITION-Cambridge cohort. Diabetes Metab Res Rev 2015; 31: 69-75.  doi: 10.1002/dmrr.2559
  25. de Grauw WJ, van de Lisdonk EH, van Gerwen WH, van den Hoogen HJ, van Weel C. Insulin therapy in poorly controlled type 2 diabetic patients: does it affect quality of life? Br J Gen Pract 2001; 51: 527-32. 
  26. Glasgow RE, Ruggiero L, Eakin EG, Dryfoos J, Chobanian L. Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care 1997; 20: 562-7. 
  27. Wang HF, Yeh MC. The quality of life of adults with type 2 diabetes in a hospital care clinic in Taiwan. Qual Life Res 2013; 22: 577-84.  doi: 10.1007/s11136-012-0178-7
  28. Alcubierre N, Rubinat E, Traveset A, Martinez-Alonso M, Hernandez M, Jurjo C, et al. A prospective cross-sectional study on quality of life and treatment satisfaction in type 2 diabetic patients with retinopathy without other major late diabetic complications. Health Qual Life Outcomes 2014; 12: 131.  doi: 10.1186/s12955-014-0131-2
  29. Spasić A, Radovanović RV, Đorđević AC, Stefanović N, Cvetković T. Quality of Life in Type 2 Diabetic Patients. Scientific Journal of the Faculty of Medicine in Niš 2014; 31: 193-200. 
  30. Collins MM, O'Sullivan T, Harkins V, Perry IJ. Quality of life and quality of care in patients with diabetes experiencing different models of care. Diabetes Care 2009; 32: 603-5.  doi: 10.2337/dc08-1169
  31. Wee HL, Tan CE, Goh SY, Li SC. Usefulness of the Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) questionnaire in patients with diabetes in a multi-ethnic Asian country. Pharmacoeconomics 2006; 24: 673-82. 
  32. Demirci H, Cinar Y, Bayram N, Bilgel N. Quality of life in type II diabetic patients in primary health care. Dan Med J 2012; 59: A4468. 
  33. Sundaram M, Kavookjian J, Patrick JH, Miller LA, Madhavan SS, Scott VG. Quality of life, health status and clinical outcomes in Type 2 diabetes patients. Qual Life Res 2007; 16: 165-77.  doi: 10.1007/s11136-006-9105-0
  34. Ministerio SyAS. Programa Nacional de Diabetes. PRONADIA, Resolución 301/1999; 1999.