Continuous subcutaneous insulin infusion therapy: effects on quality of life.

OBJECTIVE: To compare the diabetes-specific quality of life in subjects with type 1 diabetes treating their diabetes with multiple daily injections (MDI) to that of subjects on continuous subcutaneous insulin infusion (CSII).
METHODS: Diabetes-specific quality of life was measured with the DSQOLS-Questionnaire in 81 adult subjects with type 1 diabetes on MDI and 78 subjects on CSII (cross-sectional study). In addition, 19 subjects were followed prospectively, measuring their quality of life before and after switching from MDI to CSII (longitudinal study).
RESULTS: Preference-weighted treatment satisfaction score was significantly higher in subjects on CSII than in those on MDI in both the longitudinal (+63 points, 95%CI 37-89) and the cross-sectional study (+14 points, 95%CI 3 to 25). "Diet restrictions" were significantly less of a burden for CSII subjects in both the longitudinal (+6 points, 95%CI 1-10) and the cross-sectional study (+3 points, 95%CI 0 to 6). "Leisure time flexibility" (+3 points, 95%CI 0 to 7), "Physical complaints" (+4 points, 95%CI 1 to 8), "Daily hassles" (+4, 95%CI 0 to 7), and the overall quality of life (+29 points, 95%CI 3 to 54) were significantly better in CSII compared to MDI only in the longitudinal study. Despite a small overall rate of severe hypoglycaemia in both studies, subjects on CSII experienced fewer severe episodes than subjects on MDI.
CONCLUSIONS: Subjects with type 1 diabetes on CSII have a better quality of life than type 1 diabetic subjects on MDI. They are more satisfied with their treatment in respect to their metabolic goals as well as psychosocial factors, physical performance and protection from long-term complications and hypoglycaemia. Furthermore, the subjects on CSII experience greater flexibility in their daily routines, leisure time and diet than the subjects on MDI.