Integrative diabetes care is lifelong. Patient care evolves with the patient's age, shifting from strict glycaemic goals to a comprehensive assessment of health-related quality of life (HRQOL). Therefore, in addition to glycaemic control measures, research should include patient-reported outcome measures (PROMs). Diabetes treatment is based on patient empowerment, the process in which persons with diabetes acquire the knowledge and insights necessary to adjust their lifestyle habits to improve their quality of life. In parallel with the aging of the population, the assessment of HRQOL in the form of PROMs is increasingly being implemented also due to the increasing introduction of new therapies and advanced technical devices for self-management of diabetes, such as Continuous Glucose Monitoring (CGM). The scientific evidence and clinical experience with these technologies among older adults are growing, however still scarce. With bridging the knowledge gap of the characteristics of the elderly persons with diabetes subpopulation, appropriate approaches to treatment can be developed. We aimed to determine the HRQOL and metabolic characteristics of older persons with type 1 and type 2 diabetes with the use of validated questionnaires. Furthermore, we assessed the impact of the introduction of CGM on HRQOL and glycaemic control parameters.
The first part of the thesis presents HRQOL and self-assessed mental health in older persons with diabetes, revealing that in a subgroup of older adults most HRQOL domains were not associated with diabetes complications or glycaemic control. Obesity significantly impacted HRQOL, regardless of diabetes type. The first part of my doctoral thesis therefore demonstrates the contribution and importance of separate criteria of treatment outcomes, which, in addition to glycemia control, should report on the patient's aspects of treatment, captured by PROMs.
The second part elaborates on the metabolic characteristics of older people with type 1 and type 2 diabetes and demonstrates that the lifestyle of older people with type 1 diabetes involves on average more physical activity, while older people with SB2 predominantly defined their lifestyle as sedentary. The effect of the amount and intensity of physical activity on glycaemic control was only evident in a subgroup of frequent and high-intensity physically active subjects.
The third part presents the perception and effectiveness of CGM introduction in elderly with type 1 and 2 diabetes treated with multiple daily injections (MDI). CGM introduction resulted in high satisfaction and improved glucose control. The introduction of CGM in elderly persons with well-controlled diabetes was accepted without imposing additional distress in the self-management of diabetes. Furthermore, an additional benefit in glucose control was demonstrated, since the introduction of CGM stabilized glucose in the target range.
The thesis complements the scarce existing literature on HRQOL determinants in elderly patients with diabetes, emphasizing the importance of a patient-centred approach due to pronounced inter-individual differences. Incorporating and addressing the HRQOL perspective in diabetes care and research is imperative, especially for the elderly, and improves health care in the broadest sense. Understanding the perception and potential benefits of CGM in the elderly population aids with the onboarding of medical devices in technology-naïve patients and is of critical relevance for the introduction of medical devices in this group of persons with both type 1 and type 2 diabetes.
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