When insulin degludec enhances quality of life in patients with type 2 diabetes: a qualitative investigation
Tóm tắt
Anecdotal reports suggest that insulin degludec (IDeg) may offer unique health-related quality of life (HRQoL) benefits. As the nature of these benefits remain unclear, this study utilized qualitative research methods to investigate and elucidate the experience of “feeling better” after initiating IDeg. Twenty adults with type 2 diabetes (T2D) who reported “feeling better” on IDeg for > 3 months participated in 90-min interviews. One focus group and nine telephone interviews were conducted at two sites in the United States (US) and one focus group was conducted in Switzerland. Patients were ≥ 18 years of age, did not take mealtime insulin, and had switched to IDeg from another basal insulin. Discussions were audio-recorded, transcribed and translated (Swiss German). Utilizing grounded theory, transcripts were analyzed by sorting quotes into concepts using thematic analysis. Participants' mean age was 66 years and the average duration of T2D was 17.6 years. Mean duration of IDeg use was 1.45 years. Four major factors were identified as key contributors to patients’ sense of “feeling better”: 1) reduced sense of diabetes as burdensome and requiring excessive attention; 2) enhanced feelings of adaptability and freedom; 3) heightened sense of security, especially regarding concerns about hypoglycemia; and 4) greater sense of physical well-being (greater energy/less fatigue). Content saturation was achieved. Generally, patients from the US sites were more focused on medical results than Swiss patients, who were more likely to identify IDeg’s effect on overall HRQoL. A limitation of the study was that the population was primarily white, > 60 and otherwise healthy (no comorbid physical or mental condition). A group of patients with T2D, who had switched to IDeg from another basal insulin, reported HRQoL benefits which were attributed to both diabetes-specific improvements (feeling less burdened by day-to-day diabetes demands) and non-specific gains (greater energy). The conclusions may have limited transferability due to the characteristics of the sample population and further research is needed.
Tài liệu tham khảo
Evans M, Jensen HH, Bogelund M, Gundgaard J, Chubb B, Khunti K. Flexible insulin dosing improves health-related quality-of-life (HRQoL): a time trade-off survey. J Med Econ. 2013;16(11):1357–65.
Home PD, Meneghini L, Wendisch U, Ratner RE, Johansen T, Christensen TE, et al. Improved health status with insulin degludec compared with insulin glargine in people with type 1 diabetes. Diabet Med. 2012;29(6):716–20.
Freemantle N, Meneghini L, Christensen T, Wolden ML, Jendle J, Ratner R. Insulin degludec improves health-related quality of life (SF-36®) compared with insulin glargine in people with type 2 diabetes starting on basal insulin: a meta-analysis of phase 3a trials. Diabet Med. 2013;30(2):226–32.
Freemantle N, Evans M, Christensen T, Wolden ML, Bjorner JB. A comparison of health-related quality of life (health utility) between insulin degludec and insulin glargine: a meta-analysis of phase 3 trials. Diabetes Obes Metab. 2013;15(6):564–71.
Hajos TR, Pouwer F, de Grooth R, Holleman F, Twisk JW, Diamant M, et al. Initiation of insulin glargine in patients with type 2 diabetes in suboptimal glycaemic control positively impacts health-related quality of life. A prospective cohort study in primary care. Diabet Med. 2011;28(9):1096–102.
Peyrot M, Rubin RR, Kruger DF, Travis LB. Correlates of insulin injection omission. Diabetes Care. 2010;33:240–5.
Davis RE, Morrissey M, Peters JR, Wittrup-Jensen K, Kennedy-Martin T, Currie CJ. Impact of hypoglycaemia on quality of life and productivity in type 1 and type 2 diabetes. Curr Med Res Opin. 2005;21:1477–83.
Fidler C, Elmelund CT, Gillard S. Hypoglycemia: an overview of fear of hypoglycemia, quality-of-life, and impact on costs. J Med Econ. 2011;14(5):646–55.
Charmaz K. Grounded Theory. In: Smith JA, Harre R, van Langenhove L, editors. Rethinking methods in psychology. London: Sage; 1995. p. 27–49.
Lasch KE, Marquis P, Vigneux M, Abetz L, Arnould B, Bayliss M, et al. PRO development: rigorous qualitative research as the crucial foundation. Qual Life Res. 2010;19(8):1087–96.
Sandelowski M. Sample size in qualitative research. Res Nurs Health. 1995;18(2):179–83.
Charmaz K. Grounded theory in the 21st century. 3rd ed. Thousand Oaks: Sage; 2005.
Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation variability. Field Methods. 2006;18(1):59–82.
Trikkalinou A, Papazafirpopoulou AK, Melidonis A. Type 2 diabetes and quality of life. World J Diabetes. 2017;8(4):120–9.
Polonsky WH, Fisher L, Hessler D, Edelman SV. Identifying the worries and concerns about hypoglycemia in adults with type 2 diabetes. J Diabetes Complicat. 2015;29:1171–6.
Martyn-Nemeth P, Schwarz Farabi S, Mihailescu D, Nemeth J, Quinn L. Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention – a review. J Diabetes Complicat. 2016;30:167–77.
Fisher L, Polonsky WH, Hessler DM, Masharani U, Blumer I, Peters AL, et al. Understanding the sources of diabetes distress in adults with type 1 diabetes. J Diabetes Complicat. 2015;29:572–7.
Rodbard HW, Gough S, Lane W, Korsholm L, Bretler DM, Handelsman Y. Reduced risk of hypoglycemia with insulin degludec versus insulin glargine in patients with type 2 diabetes requiring high doses of basal insulin: a meta-analysis of 5 randomized begin trials. Endocr Pract. 2014;20:285–92.
Ratner RE, Gough SC, Mathieu C, Del Prato S, Bode B, Mersebach H, et al. Hypoglycaemia risk with insulin degludec compared with insulin glargine in type 2 and type 1 diabetes: a pre-planned meta-analysis of phase 3 trials. Diabetes Obes Metab. 2013;15:175–84.
Flick U. An introduction to qualitative research. Fourth ed: Published in Thousand Oaks: Sage Publications; 2009. p. 194–209.
Bowling A, Ebrahim S, editors. Handbooks of Health Research Methods: Investigations, measurement and analysis: Published in Maidenhead, Berkshire: Open University Press; 2005. p. 220–1. 515
Kamberelis, George and Dimitriadis G?, “Focus groups: strategic Articulatiosn of pedagogy, politics, and inquiry,” in Denzin, Norman K. and Yvonna S. Lincoln, eds. The Sage Handbook of Qualitative Research, Third. Thousand Oaks: Sage Publications; 2005. Pp. 898–906.