Assessment of quality of life, psychological parameters and glycemic variability in DM1 patients

Introduction: This study aims to evaluate the relationships between the Glycemic Risk Index (GRI) and other continuous glucose monitoring (CGM) metrics, with quality of life, diabetes management, sleep quality, perceived pain, psychopathological symptoms, anxiety, and depression in patients with type 1 diabetes (TDM1). Methods: an observational cross sectional study; 130 patients (age 43.7±12,8 yrs, BMI 24.9±4,5kg/m2, disease duration 23.2±12.3 yrs, HbA1c 7.0±0.9%, 68/62females/males). Patients were divided into three groups (45 with MDI, 35 with traditional insulin pump-CSII, 50 with Advanced Hybrid Closed-Loop system-AHCL). Their assessments included Audit of Diabetes Dependent Quality of Life (ADDQoL), Problem Areas In Diabetes 20 items (PAID-20), Hypoglycemia Fear Survey II (HFSII), Pittsburg Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Symptom CheckList 90, McGill Pain Questionnaire – Short Form, Personality Inventory 5. Results: According to HADS, all patients were categorized as depressed. The ‘freedom to eat’ sub-item of ADDQoL, was significantly associated with GRI (p=0.03) and HbA1c (p=0.005). GRI showed significant associations with Paranoid Ideation by SCL-90 (p=0.014), avoidance behaviors by HFSII (p=0.011), Sleep Latency (p=0.034), and Daytime Dysfunction (p=0.029) by PSQI in all patients. The AHCL group had higher proportion of pathological patients for emotional lability than the other groups (32%, CSII 14.29%, MDI 11.11%; p=0.029), however all the metrics were better than the other groups (GRI p=0.018, TIR p=0.022, TAR>250 p=0.046). Conclusions: This is the first study using a wide range of questionnaires to evaluate psychophysical well-being of TDM1. It identified a detrimental cycle linking difficulties in managing the disease, its impact on the quality of life, poor sleep quality, emotional lability and depressive aspects with a parallel worsening of the metrics. However AHCL demonstrated the capacity to mitigate the adverse effects of poor glycemic control associated with pathological personality traits.