7/30/2019 Quality if Life
1/1
OBSERVATIONS
Quality of Life,Coping Ability, andMetabolic Control inPatients
With Type 1Diabetes ManagedBy Group Care and aCarbohydrateCounting
Program
Group care is a clinical-pedagogicmodel in which traditional
routinevisits are substituted by sessions of
group education. This approach im-proves quality of life and
metabolic con-trol in patients with type 2 diabetes (1)but only
quality of life in those with type 1diabetes (2). The latter must
match mul-tiple daily insulin administrations withblood glucose
monitoring, dietary intake,and energy expenditure (3). We
hypoth-esized that to improve their coping strat-egies, patients
with type 1 diabetes needmore specific training in the technical
as-pects of day-to-day management of insu-lin therapy. To verify
this, we studied theeffects of embedding a carbohydratecounting
program within group care on
quality of life, knowledge of diabetes,coping ability, and
metabolic control.
Of 56 patients with type 1 diabetesalready followed by group
care, 27 wererandomized to receive an eight-sessioncarbohydrate
counting program and 29continued a more generic curriculum(control
subjects). Inclusion criteria were:age 70 years, onset of diabetes
beforeage 30 years, and having started insulintreatment within 1
year of diagnosis. Allpatients were on four-daily injections
andself-monitored blood glucose. None re-fused to participate, and
all gave their in-formed consent to the study, whichconformed with
the principles of the Hel-sinki Declaration. Quality of life,
knowl-edge, and coping ability were measuredby questionnaires (1,4)
at baseline and af-
ter 30 months. A1C, body weight, bloodglucose, hypoglycemic
episodes, and in-sulin dosages were checked every 3months.
All patients complete d the study.Compared with baseline, the
quality oflife score improved (P 0.0001) in boththe patients on the
carbohydrate counting
program (88.7 9.2 vs. 78.0 9.9) andthe control subjects (88.7
12.5 vs.80.4 11.7). However, knowledge(9.3 1.7 vs. 10.6 0.6, P
0.0001)and the three coping areas (problem solv-ing: 28.1 1.9 vs.
30.0 1.6, P 0.0001; social support seeking: 18.0 4.4 vs. 16.9 5.1,
P 0.05; and avoid-ance: 16.7 3.6 vs. 14.8 3.5, P 0.005) improved
only in the former. Allthese variables showed a greater, thoughnot
statistically significant, improvementin patients with poor
education levels. Af-
ter 30 months, A1C was lower in the pa-tients on carbohydrate
counting than inthe control subjects (7.2 0.9% vs.7.9 1.4%, P
0.05). Insulin dosage,hypoglycemic episodes, and blood lipidsdid
not change.
It was suggested that patients tend tocope with diabetes by
avoiding the nega-tive emotions associated with their dis-ease
rather than adjusting to the demandsandchallenges posed by it.This
strategy isconsidered less adaptive (5). Our resultsconfirm that
group care improves quality
of life in patients with type 1 diabetes (2)and suggest that
specific educational andpsychological supports are needed to
im-prove adaptation to the disease. In fact, allthree areas
explored by the coping ques-tionnaire were modified in directions
thatsuggest better adaptation. Knowledgeabout nutritional aspects
improved inboth treatment groups but after adjustingfor all control
variables, the improvementremained significant only in the
patientsfollowed by carbohydrate counting, par-ticularly those
patients with poor educa-tion levels. We suggest that offering
acarbohydrate counting program within agroup care management
approach mayhelp patients with type 1 diabetes acquirebetter
self-efficacy and restructure theircognitive and lifestyle
potential.
MARINA TRENTO, MES, MBA1
ENRICA BORGO1
CLAUDIA KUCICH, MD1
PIETRO PASSERA, MD1
ANNA TRINETTA, BS1
LORENA CHARRIER, MD2
FRANCO CAVALLO, MD2
MASSIMO PORTA, MD, PHD1
From 1the Laboratory of Clinical Pedagogy, Depart-ment of
Internal Medicine, University of Turin,Turin, Italy; and the
2Department of PublicHealth and Microbiology, University of
Turin,Turin, Italy.
Corresponding author: Marina Trento, [email protected].
DOI: 10.2337/dc09-0903 2009 by the American Diabetes
Association.
Readers may use thisarticle as long asthe work isproperly cited,
the use is educational and not forprofit, and the work is not
altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/
fordetails.
Acknowledgments No potential conflictsof interest relevant to
this article werereported.
References1. Trento M, Passera P, Borgo E, Tomalino
M,Bajardi M,Cavallo F, Porta M. A 5-yearrandomized controlled
study of learning,problem solving ability, and quality of
lifemodifications in people with type 2 dia-betes managed by group
care. DiabetesCare 2004;27:670 675
2. Trento M, Passera P, Borgo E, Tomalino
M, Bajardi M, Brescianini A, Tomelini M,Giuliano S, Cavallo F,
Miselli V, BondonioP, Porta M. A 3-year prospective random-ized
controlled clinical trial of group carein type 1 diabetes. Nutr
Metab CardiovascDis 2005;15:293301
3. DAFNE Study Group. Training in flexi-ble, intensive insulin
management to en-able dietary freedom in peoplewith type 1diabetes:
dose adjustment for normal eat-ing (DAFNE) randomised controlled
trial.BMJ 2002;325:746
4. Amirkhan JH. A factor analytically de-rived measure of
coping: The CopingStrategy Indicator. Journal of Personality
and Social Psychology 1990;59:1066-1074
5. de Ridder D, Schreurs K. Developing in-terventions for
chronically ill patients: iscoping a helpful concept? Clinical
Psy-chology Review 2001;21:205240
O N L I N E L E T T E R S
e134 DIABETES CARE, VOLUME 32, NUMBER 11, NOVEMBER 2009
care.diabetesjournals.org
