For many doctors who treat people with diabetes, the default approach to managing blood glucose levels is intensive, or “tight,” control. This generally means keeping blood glucose levels as close to normal (nondiabetic levels) as possible without experiencing too many negative side effects, such as hypoglycemia (low blood glucose).
This approach makes sense for a large number of people with diabetes. But due to a variety of reasons — including the risk of hypoglycemia, but also the need to manage other health conditions — some people do better with a less intensive approach to blood glucose control. And a recent study shows that taking an individualized approach has multiple benefits.
Measuring treatment outcomes
Published in December 2017 in the journal Annals of Internal Medicine, the study compared the cost-effectiveness of individualized versus uniform intensive control — defined as an HbA1c (a measure of long-term blood glucose control) target of less than 7% — in people with Type 2 diabetes. Using data from the U.S. National Health and Nutrition Examination Survey (NHANES), the researchers found that individualized blood glucose goals saved an average of $13,547 per patient each year — mostly due to lower drug costs.
Individualized control was associated with a slightly shorter life expectancy among participants — 20.63 years from the start of the study, versus 20.73 years. Not surprisingly, this was due to a higher rate of diabetes complications in people with less intensive blood glucose control. But once quality of life was adjusted for, individualized control came out ahead. Using a measure called quality-adjusted life years (QALYs), the researchers found that participants who received individualized treatment lived an additional 16.68 QALYs, versus 16.58 in the intensive treatment group.
Predicting quality of life
In another recent study, researchers looked directly at what factors affected quality of life in 5,813 people with Type 2 diabetes. Published in November 2017 in the journal Diabetes Care, the study found that most participants considered their quality of life good. But more participants worried about their high and low blood glucose levels than their doctors estimated, and intensifying someone’s diabetes treatment — by adding oral drugs to reach a total of three, or adding insulin to oral drugs — was associated with a worse reported quality of life.
Using insulin by itself was also associated with a decreased quality of life, as well as greater worry about hypoglycemia, compared with not using insulin — suggesting that fear of hypoglycemia played a role in participants’ worse quality of life.
As the researchers noted, this study reinforces the importance of measuring quality of life, in addition to other health-related measures, when evaluating a treatment for diabetes. It’s unclear, though, how many doctors take patients’ reporting on their quality of life — or the suspected impact on quality of life — into account when making treatment recommendations.
What’s your take on how your diabetes treatment affects your quality of life — do you worry a lot about hypoglycemia, or about your glucose rising too high? Do you think your treatment plan has an overall positive or negative effect on your quality of life? Did you discuss the impact your treatment plan would have on your daily life when deciding on it with your doctor? Would you take a slightly higher risk of diabetes complications in exchange for less daily worry? Leave a comment below!
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