Multicentre study to assess quality of life and glycaemic control of Type 2 diabetic patients treated with insulin compared with oral hypoglycaemic agents

Quality of life, glycaemic control and frequency of hypoglycaemia were compared in 93 moderate to poorly controlled Type 2 diabetes patients randomly allocated to one of three treatment groups: Group A continued on oral hypoglycaemics, Group B switched to twice‐daily fixed mixture of human insulin using a standard syringe, Group C switched to similar insulin given by a Becton‐Dickinson (B‐D) insulin pen. After 12 weeks patients in Groups B and C were changed to B‐D pen or syringe respectively for a further 12 weeks. Patients in Group A continued on oral hypoglycaemics. At entry, 12 weeks and 24 weeks, subjects completed a ‘well‐being’ and ‘satisfaction with treatment’ questionnaire. At the end of the study, patients in Groups B and C completed an ‘insulin delivery acceptability’ questionnaire.

There was no significant difference between scores for the ‘well‐being’ and ‘satisfaction with treatment’ questionnaires but, for those patients on insulin, the ‘insulin delivery acceptability’ questionnaire demonstrated a marked preference in most patients for the pen rather than the syringe as the method of insulin delivery. Patients on insulin showed an improvement overall in HbA_1c, with a mean reduction of 1.46% (95% confidence interval–2.76 to −0.16%, p=0.021) compared with tablet treatment, but at the expense of an increased frequency of hypoglycaemia and weight gain.

We conclude that in ‘moderately’ controlled Type 2 diabetes there is no significant change in quality of life when patients are switched to insulin, although once on insulin, most prefer an insulin pen to a syringe. The improvement in HbA_1c may, however, be of clinical significance given the increasingly powerful evidence associating good diabetes control with reduced risk of long‐term microangiopathic complications.