Diabetologia

, Volume 34, Supplement 1, pp S150–S157 | Cite as

Quality of life in Type 1 (insulin-dependent) diabetic patients prior to and after pancreas and kidney transplantation in relation to organ function

  • W. Piehlmeier
  • M. Bullinger
  • J. Nusser
  • A. König
  • W. -D. Illner
  • D. Abendroth
  • W. Land
  • R. Landgraf
Quality of Life

Summary

Improvement of the quality of life in Type 1 (insulin-dependent) diabetic patients with severe late complications is one of the main goals of pancreas and/or kidney grafting. To assess the influences of these treatment modalities on the different aspects of the quality of life a cross-sectional study in 157 patients was conducted. They were categorized into patients pre-transplant without dialysis (n=29; Group A), pre-transplant under dialysis (n=44; Group B), post-transplant with pancreas and kidney functioning (n=31; Group C), post-transplant with functioning kidney, but insulin therapy (n=29; Group D), post-transplant under dialysis and insulin therapy again (n=15; Group E) and patients after single pancreas transplantation and rejection, with good renal function, but insulin therapy (n=9; Group F). All patients answered a mailed, self-administered questionnaire (217 questions) consisting of a broad spectrum of rehabilitation criteria. The results indicate a better quality of life in Groups C and D as compared to the other groups. In general the scores are highest in C, but without any significant difference to D. Impressive significant differences between C or D and the other groups were found especially in their satisfaction with physical capacity, leisure-time activities or the overall quality of life. The satisfaction with the latter is highest in C (mean±SEM: 4.0±0.2 on a 1 to 5-rating scale; significantly different from A: 3.1±0.1, B: 2.7±0.2 and E: 2.6±0.3; p<0.01), followed by D (3.8±0.2; significantly different from B and E; p<0.01). Group F shows a mean of 3.1±0.4, which is not significantly different from C. The percentages of patients in each group, who are not working: A: 38 %, B: 64 %, C: 74 %, D: 66 %, E: 87 % and F: 78 % indicate that there is no marked improvement in the vocational situation after successful grafting.

Key words

Diabetes mellitus Pancreas transplantation Kidney transplantation Quality of life Rehabilitation 

References

  1. Aaronson NC (1989) Quality of life assessment in clinical trials: methodologic issues. Contr Clin Trials 10: 195S–208SGoogle Scholar
  2. Andrykowsky MA, Henslee PJ, Farall MG (1987) Physical and psychological functioning of adult survivors of allogenic bone marrow transplantation. Bone Marrow Transpl 4: 153–157Google Scholar
  3. Bremer BA, McCauley CR (1986) Quality-of-life measures: hospital interview versus home questionnaire. Health Psychology 5(2): 171–177Google Scholar
  4. Bullinger M (1989) Concepts and methods of quality of life assessment. In: Fülgraff GM, Franke H, Lenau H, Rohde H (eds). Clinical pharmacology — current state and future aspects. CRF Press, Freiburg, pp 73–92Google Scholar
  5. Bullinger M, Angermann C, Zellner M, Spes C, Kemkes M (1991) Lebensqualität nach Herztransplantation. In: Bullinger M, Ludwig M, Steinbüchel N. Lebensqualität bei kardiovaskulären Erkrankungen. Hogrefe und Huber, Göttingen, pp 153–163Google Scholar
  6. Bullinger M. Quality of life — methodologist's view. Theoretical Surgery, in press.Google Scholar
  7. Corry RJ, Zehr P (1990) Quality of life in diabetic recipients of kidney transplants is better with the addition of the pancreas. Clin. Transplantation 4: 238–241Google Scholar
  8. DCCT Reaearch Group (1988) Reliability and validity of a diabetes quality-of-life measure for the Diabetes Control and Complications Trial. Diabetes Care 11: 725–732Google Scholar
  9. Derogatis LR (1975) Psychosocial adjustment to illness scale. Clinical Psychosomatic Research. Baltimore.Google Scholar
  10. Evans RW, Manninen DL, Garrison LP, Hart LG, Blazz CR, Gutman RA, Hull AR, Lowrie EG, (1985) The quality of life of patients with end-stage renal disease. N Engl J Med 312: 553–559Google Scholar
  11. Guyatt GH, Bombardier C, Tugwell PX (1986) Measuring disease-specific quality of life in clinical trials. Can Med Ass J 134: 889–895Google Scholar
  12. Hart LG, Evans RW (1987) The functional status of ESRD patients as measured by the sickness impact profile. J Chron Dis 40, Suppl 1, 117S-130SGoogle Scholar
  13. Johnson JL, Schellberg J, Munn SR, Perkins JD (1990) Does pancreas transplantation really improve the patient's quality of life? Transplantation Proceedings 22: 575–576Google Scholar
  14. Kaplan De-Nour A, Shanan J (1980) The quality of life of dialysis and transplanted patients. Nephron 25: 117–120Google Scholar
  15. Kemkes BM. Quality of life issues in heart transplantation. Theoretical Surgery, in press.Google Scholar
  16. Koostra G. Quality of life issues in renal surgery. Theoretical Surgery, in pressGoogle Scholar
  17. Leighton R, Quinn RJ, Hoefer MA (1987) Measuring overall health: an evaluation of three important approaches. J Chron Dis 40, Suppl 1, 7S-21SGoogle Scholar
  18. McDowell I, Newell C (1987) Measuring Health: A guide to rating scales and questionnaires. Oxford University Press, New York.Google Scholar
  19. Muthny FA, Broda M, Dinger A, Koch U, Stein B (1990) Aspekte der Lebensqualität bei verschiedenen Behandlungsverfahren der chronischen Niereninsuffizienz — ein empirischer Vergleich. Blutreinigungsverfahren, ed. Franz H, Thieme, Stuttgart, pp 205–210Google Scholar
  20. Najman JM, Levine S (1981) Evaluating the impact of medical care and technologies on the quality of life: review and a critique. Social Science in Medicine 15: 107–115Google Scholar
  21. Nakache R, Tyden G, Groth CG (1989) Quality of life in diabetic patients after combined pancreas-kidney or kidney transplantation. Diabetes 38: 40–42Google Scholar
  22. Neugebauer E, Wood-Dauphinee S, Troidl H, Eypasch E, Bullinger M. Quality of life assessment in surgery — consensus results of the Meran Conference. Theoretical Surgery, in press.Google Scholar
  23. O'Young I, McPeek B (1987) Quality of life variables in surgical trials. J Chron Dis 40: 513–522Google Scholar
  24. Patrick DL, Erickson P (1988) Assessing health-related quality of life for clinical decision making. In: Walker SR, Rosser RM (eds) Quality of life: assessment and application. MTP Press, Lancaster, pp 183–197Google Scholar
  25. Troidl H, Kusche J, Vestweber KH, Eypasch E, Koeppen L, Boullon B (1987) Quality of life: an important endpoint both in surgical practice and research. J Chron Dis 40: 523–528Google Scholar
  26. Vorugati LNP, Sells RA (1989) Quality of life of diabetic patients after combined pancreatic-renal transplantation. Clin Transplantation 3: 78–82Google Scholar
  27. Walker SR, Rosser RM (1988) Quality of life assessment and application. MTP Press, LancasterGoogle Scholar
  28. Wood-Dauphinee S, Troidl H (1986) Endpoints for clinical studies: Conventional and innovative variables. In: Troidl H, Spitzer WO, McPeek B, Mulder DS, McKneally MF (eds.) Principles and practice of research strategies for surgical investigators. Springer, New York, pp 53–68Google Scholar
  29. Wood-Dauphinee S, Williams JI (1987) Reintegration to normal living as a proxy to quality of life. J Chron Dis 40: 491–499Google Scholar
  30. Wood-Dauphinee S, Troidl H (1989) Assessing quality of life in surgical studies. Theor Surg 4: 35–44Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • W. Piehlmeier
    • 1
  • M. Bullinger
    • 3
  • J. Nusser
    • 1
  • A. König
    • 1
  • W. -D. Illner
    • 2
  • D. Abendroth
    • 2
  • W. Land
    • 2
  • R. Landgraf
    • 1
  1. 1.Department of Internal Medicine “Innenstadt”University of MunichMunichGermany
  2. 2.Transplantation CenterUniversity of MunichMunichGermany
  3. 3.Institute for Medical PsychologyUniversity of MunichMunichGermany

Personalised recommendations