Алекс , начав обсуждение вопроса о доказательной медицине применительно к DCCT , Вы сообщили как о недостатке DCCT отсутствие данных по качеству жизни . Обсуждая Ваше замечание с д.м.н. Е. Старостиной , я узнала , что это высказываение неточно , и в DCCT обсуждались эти моменты . Вот 2 навскидку ссылки .
До нашего разговора я не обращала внимание на эту часть DCCT . Мне просто любопытно - Вы специально анализировали этот раздел и решили . что его качество неудовлетворительно, как сложилось ВАше мнение ?
Patient Educ Couns. 1997 Feb;30(2):167-73. Related Articles, Links
Effect of patient-selected intensive insulin therapy on quality of life.
Chantelau E, Schiffers T, Schutze J, Hansen B.
Diabetesambulanz MNR-Klinik, Dusseldorf, Germany.
The purpose of the study was to assess quality of life in patients with IDDM in relation to the type of insulin therapy. Two patient cohorts were studied. In cohort A, 77 patients deliberately intensified their traditional insulin injection therapy from up to two daily injections with syringe to multiple daily injections with insulin-pen; in cohort B, 55 patients changed from intensive therapy with pen to insulin pump-treatment (CSII). The therapeutic regimens were changed during a 5-day in-patient treatment and teaching course. The DCCT questionnaire was applied before and up to 6 months after changing of therapy. Treatment satisfaction increased after intensification of insulin therapy in both groups, mainly due to greater flexibility with leisure-time activities, and with the diet. Pump-users reported reduced problems with hypoglycemia (P < 0.02). HbA1c indicating acceptable metabolic control already before the study, remained unchanged. Therapy-associated inconvenience, mainly in association with lifestyle, improved in IDDM patients deliberately intensifying their insulin therapy by pens or pumps (CSII). Pump-treatment, rather than pen-therapy, conferred particular protection from hypoglycaemia.Diabetes Care. 1996 Mar;19(3):195-203. Related Articles, Links
Comment in:
ACP J Club. 1996 Jul-Aug;125(1):19.
Influence of intensive diabetes treatment on quality-of-life outcomes in the diabetes control and complications trial.
[No authors listed]
OBJECTIVE: To evaluate the effect of intensive diabetes treatment on patient quality of life assessed by the Diabetes Quality-of-Life Measure, the Symptom Checklist-90R, the Medical Outcome Study 36-Item Short Form Survey, and intercurrent psychosocial events in the Diabetes Control and Complications Trial (DCCT). RESEARCH DESIGN AND METHODS: The DCCT was a 29-center prospective controlled clinical trial that demonstrated the beneficial effect of intensive diabetes treatment on retinopathy, nephropathy, and neuropathy. The 1,441 volunteers with IDDM, aged 13-39 years, were randomly assigned to intensive or conventional diabetes therapy. The volunteers were followed for a mean of 6.5 years (range 3-9 years). Quality-of-life data were collected during annual visits. Of the volunteers, 99% completed the study, and > 95% of scheduled tests were completed. RESULTS: All analyses of quality of life, psychiatric symptom indexes, and psychosocial event data showed no differences between intensive and conventional diabetes treatment. CONCLUSION: Under careful treatment conditions, such as those followed in the DCCT, patients undergoing intensive diabetes treatment do not face deterioration in the quality of their lives, even while the rigor of their diabetes care is increased.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 8742561 [PubMed - indexed for MEDLINE]
Честно скажу - я просто была невнимательна и забыла о публикации 1996 г - спасибо ще раз . что вернули к этой проблеме.
--------------------------------------------------------------------------------
|