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

Piehlmeier, W.; Bullinger, M.; Nusser, J.; König, A.; Illner, Wolf-Dieter; Abendroth, D.; Land, Walter und Landgraf, R. (1991): Quality of life in Type 1 (insulin-dependent) diabetic patients prior to and after pancreas and kidney transplantation in relation to organ function. In: Diabetologia, Bd. 34, Nr. Supple: S. 150-157

Abstract

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.

• Dokumententyp: Zeitschriftenartikel
• Keywords: Diabetes mellitus, Pancreas transplantation, Kidney transplantation, Quality of life, Rehabilitation
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Signatur: UBM:0760/4 Med.GZ 54(34

Literaturliste

Aaronson NC (1989) Quality of life assessment in clinical trials: methodologic issues. Contr Clin Trials 10: 195S–208S

Andrykowsky MA, Henslee PJ, Farall MG (1987) Physical and psychological functioning of adult survivors of allogenic bone marrow transplantation. Bone Marrow Transpl 4: 153–157

Bremer BA, McCauley CR (1986) Quality-of-life measures: hospital interview versus home questionnaire. Health Psychology 5(2): 171–177

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 73–92

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 153–163

Bullinger M. Quality of life — methodologist's view. Theoretical Surgery, in press.

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: 238–241

DCCT Reaearch Group (1988) Reliability and validity of a diabetes quality-of-life measure for the Diabetes Control and Complications Trial. Diabetes Care 11: 725–732

Derogatis LR (1975) Psychosocial adjustment to illness scale. Clinical Psychosomatic Research. Baltimore.

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: 553–559

Guyatt GH, Bombardier C, Tugwell PX (1986) Measuring disease-specific quality of life in clinical trials. Can Med Ass J 134: 889–895

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-130S

Johnson JL, Schellberg J, Munn SR, Perkins JD (1990) Does pancreas transplantation really improve the patient's quality of life? Transplantation Proceedings 22: 575–576

Kaplan De-Nour A, Shanan J (1980) The quality of life of dialysis and transplanted patients. Nephron 25: 117–120

Kemkes BM. Quality of life issues in heart transplantation. Theoretical Surgery, in press.

Koostra G. Quality of life issues in renal surgery. Theoretical Surgery, in press

Leighton R, Quinn RJ, Hoefer MA (1987) Measuring overall health: an evaluation of three important approaches. J Chron Dis 40, Suppl 1, 7S-21S

McDowell I, Newell C (1987) Measuring Health: A guide to rating scales and questionnaires. Oxford University Press, New York.

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 205–210

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: 107–115

Nakache R, Tyden G, Groth CG (1989) Quality of life in diabetic patients after combined pancreas-kidney or kidney transplantation. Diabetes 38: 40–42

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.

O'Young I, McPeek B (1987) Quality of life variables in surgical trials. J Chron Dis 40: 513–522

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 183–197

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: 523–528

Vorugati LNP, Sells RA (1989) Quality of life of diabetic patients after combined pancreatic-renal transplantation. Clin Transplantation 3: 78–82

Walker SR, Rosser RM (1988) Quality of life assessment and application. MTP Press, Lancaster

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 53–68

Wood-Dauphinee S, Williams JI (1987) Reintegration to normal living as a proxy to quality of life. J Chron Dis 40: 491–499

Wood-Dauphinee S, Troidl H (1989) Assessing quality of life in surgical studies. Theor Surg 4: 35–44