Diabetes og livskvalitet

Diabetes mellitus is a chronic metabolic disease caused by insufficient production or insufficient effect of insulin. The disease is treated with insulin or other anti-diabetic drugs, but a large percentage of the diabetic population manages without medications, only making lifestyle changes, i.e. changes in diet and physical activity. The insidence of people diagnosed with diabetes is increasing in the western world, but also in developing countries. Obesity is perhaps the most important factor associated with diabetes. Life expectancy is lower for people with diabetes, compared to people without the disease. In this report, we have analysed data collected by HUNT, The North-Trøndelag Health Survey, the first carried out in 1984-86 and the second in 1995-97. Questionnaires were presented to the entire adult population in the county, including questions related to subjective well-being, e.g. life satisfaction, loneliness, sleeping problems, nervousness. People diagnosed with diabetes are compared with people with other diseases, such as cardiovascular diseases, and with people with various functional impairments, e.g. hearing and sight impairments, and with people with no known disease or disability. Lower subjective well-being Diabetic patients report lower subjective well-being than people without any known disease/impairment. The differences are small but statistically significant. Compared to people with other diseases, the diabetic patients have a higher well-being, but they report slightly lower well-being than people with impaired hearing. Complications, e.g. cardiovascular diseases and sight impairmens, are frequently related to the diabetic condition. Diabetic patients with no other diseases report higher well-being than patients with complications. The second HUNT survey shows that the incidence of diabetes have increased during the eleven years between the two studies. However, the percentage of diabetic patients who have experienced complications, are reduced. Their subjective well-being is higher in the second survey than in the first. Lowered ambitions The survey data were supplemented with 21 personal interviews carried out by the two authors of this report. In these interviews, we discussed with the diabetic patients questions related to their disease and their well-being. Some of the interviewees state that their well-being is definitely not reduced by their diabetic condition, but that their life is probably somewhat different from what it would have been without the disease. For instance, they had lowered their ambitions in certain areas, and at the same time they have to live a healthy life, with exercises and diet restrictions. Some of the interviewees consider these precautions a burden, limiting their activities and their possibilities for a full life. Stigma related to having a chronic disease is discussed. The interviewees seem to perceive little stigma, and some think the stigma have decreased in the Norwegian population as a result of an improved popular health education. Coping Coping behavior is crucial when living with a disease. In the litterature on coping strategies there is a discussion going onrelated to the advantages and disadvantages of self-deception and wishful thinking, or what has been termed positive cognitive bias. There is agreement on the necessity of accepting a diagnosis as a diabetic patient. However, optimism, more or less well founded, concerning the likelihood of complications and other unwanted consequences, may contribute to the enhancement of a person's quality of life. Social support There is unanimous agreement on the advantages of social support. Empirical studies have shown that the most efficient strategy when encountering stressful life conditions, is to seek social support. Not all people have the social nettwork necessary or the ability to make use of it. Hence it is a challenge to the health services to give the diabetic patient the support they need and encourage and assist them in socializing with friendsand family