Methods: This study adopted a 9-month observational study design. Overall, 183 insulin-treated patients with T2DM were recruited from two endocrinology clinics in Taiwan by convenience sampling. At baseline, a self-reported questionnaire was used to collect demographic and disease characteristics, regimen adherence factors (adherence in frequency of insulin injection and self-monitoring blood glucose), and psychosocial factors (decisional balance for insulin injection, health literacy, self-efficacy for insulin injection, diabetes distress, empowerment perceptions), and QoL. HbA1c levels at baseline were collected from medical records. QoL was measured at baseline and 9 months later.
Results: The mean age of participants was 55.52 (SD=11.1). Most participants were male (n=114, 62.3%). In bivariate correlation analysis, baseline age (r=0.209, p=0.002), duration of diabetes (r=0.171, p=0.010), adherence in frequency of insulin injection (r=-0.180, p=0.007), decisional balance for insulin injection (r=0.235, p=0.001), self-efficacy (r=0.287, p<0.001), and diabetes distress (r=-0.528, p<0.001) were significantly correlated with 9-month QoL. Gender (r=0.027, p=0.359), HbA1c levels (r=-0.082, p=0.134), duration of insulin injection (r=0.062, p=0.201), adherence in self-monitoring blood glucose (r=-0.029, p=0.350), health literacy (r=0.055, p=0.228), empowerment perception (r=0.084, p=0.128) were not significantly correlated with 9-month QoL. After adjusting baseline QoL, multiple regression indicated that age (β=0.189, p=0.012), adherence in frequency of insulin injection (β=-0.133, p=0.04), diabetes distress (β=-0.286, p=0.004) were important predictors of 9-month QoL and explained 34.0% variance of 9-month QoL.
Conclusion: Results supported that patients with younger age should be considered a risk group for developing poor QoL. The higher the diabetes distress at baseline, the poorer the QoL 9 months later. Regularly assessing diabetes distress and providing early intervention is necessary for insulin-treated patients. Insulin-treated patients who more adhere to established frequencies of insulin injection might perceive high stress because of more interruption of daily activities; finally, leading to developing poor QoL. Therefore, healthcare providers should educate insulin-treated patients how to balance the schedules of insulin injections in their daily lives.