WELL-BEING AND SYMPTOMS IN RELATION TO INSULIN THERAPY IN TYPE-2 DIABETES

OBJECTIVE - To determine the influence of insulin therapy on physical symptoms, emotional and general well-being, and treatment satisfaction in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - A des criptive prospective 2-year cohort study was performed. The study popu lation consisted of 272 eligible NIDDM patients of Dutch origin greate r than or equal to 40 years of age who had a known diabetes duration g reater than or equal to 3 months and who were treated with diet and/or oral hypoglycemic agents. Dependent variables in the logistic regress ion analysis were scores on the Type 2 Diabetes Symptom Checklist, the Profile of Mood States, and questions regarding general well-being an d treatment satisfaction. Potential determinants under study were age, sex, known diabetes duration, insulin dose, duration of insulin thera py, comorbidity baseline and change in metabolic parameters and cardio vascular risk factors. RESULTS - A baseline and 2-year questionnaire w ere available for 157 patients (58%). During follow-up, 39 of them (24 .8%) were treated with insulin. Initiation of insulin therapy was sign ificantly associated with improved glycemic control (mean HbA(1c) 8.2 +/- 1.4 [SD] to 7.4 +/- 0.9%, P = 0.001) and weight gain (BMI 27.1 +/- 3.9 to 28.6 +/- 4.3 kg/m(2), P = 0.000). Of all symptom and well-bein g scores, only feelings of emotional fatigue worsened significantly al though modestly (0.4-1.7 on a scale of 0.0-10.0, P = 0.02). Although d iabetes management with insulin was experienced as more demanding (P = 0.04), treatment satisfaction scores were not adversely influenced (2 .5-1.9, P = 0.39). High insulin doses were significantly and independe ntly associated with high symptom scores (total score, hypoglycemic sc ore) and with low mood (displeasure score, anger, tension, emotional f atigue) and perceived state of health. CONCLUSIONS - Initiation of ins ulin therapy in type 2 diabetes improves glycemic control effectively has little influence on physical and psychological well-being dimensio ns, and does not affect treatment satisfaction.