As stated by the World Health Organisation (WHO), Quality of life is “an individual’s perception of their position in life in the context of the culture and value systems in which they live and with their goals, expectations, standards, and concerns”.
Health-related Quality of life, on the other hand, is used to measure self-perceived health or disease status and to understand the distinction between various aspects of life-related to Health. Recently, there has been an increasing interest in Quality of life issues, especially Health-related Quality of life.
Diabetes, a long-term condition, is well associated with quality of life. According to the International Diabetes Federation, globally, an estimated 537million people had diabetes in 2021, which is expected to reach 643 million by 2030. Approximately 74 million adults (age 20-79 years) have diabetes in India, which equals 1 in 12 adults. About 2.2 lakh children and adolescents (0-19) have Type 1 diabetes.
- Type 1 diabetes (T1D) is an “autoimmune disease leading to absolute insulin deficiency
- Type 2 diabetes (T2D) occurs due to progressive insulin secretion frequently on the background of insulin resistance).
It is said that Quality of life (QOL) is low in patients with diabetes with persistent fatigue and tiredness due to elevated blood glucose levels and exhaustion due to low glucose levels. As per the studies, poor glycemic control and poor sleep quality negatively affect health-related quality of life among type 2 diabetes patients. Psychological complications such as anxiety and depression are prevalent in these patients and impact their everyday functioning, contributing to low quality of life. The psychosocial toll of living with diabetes is often heavy, which may affect self-care behaviour and, ultimately, long-term glycemic control, the risk of developing long-term complications, and decreased Quality of life.
Patients with Type 1 diabetes often feel challenged by their disease and its day-to-day management demands. Some problems are disturbed family life, freedom to eat as I wish, and self-confidence. As “dietary freedom” is the most impacted aspect of life for people with diabetes, it is hard to resist. “Freedom to eat as I wish” indicates the dietary restrictions that considerably negatively impact the QOL of people with diabetes.
Importance of protection and improvement of QOL through DAFNE trial
However, it is reported by many countries that interventions that promote dietary freedom do much to improve the QOL of patients with Type 1 patients. Patients treated with insulin are reported to have a negative impact on their QOL than those treated with tablets or diet alone. The DAFNE trial (Dose adjustment for normal eating) is an intensive insulin regimen combining dietary freedom with insulin adjustment” had initially experimented on patients of United Kingdom. Patients were trained to match their insulin levels with their food choices while keeping their blood glucose level close to control. The validated measures depend upon the most essential aspects of life, condition-specific, impact rating of diabetes and the perceived importance of each aspect. People with diabetes demonstrated highly significant improvements in quality of life from training in insulin dose adjustment to providing dietary freedom without loss of diabetes control. Studies recommended using the DAFNE trial all over India to help improve the Quality of life of people.