Exploration of the quality of life issues/benefits associated with continuous subcutaneous insulin infusion in Type 1 diabetes

Continuous Subcutaneous Insulin Infusion (CSII) represents the latest technology in insulin delivery and, whilst demanding, arguable provides additional QoL benefits to other insulin regimens. Existing literature provides mixed reports regarding QoL benefits associated with CSII. However, poor methodology, small samples and inappropriate measures may explain this ambiguity. Due to the subjective nature of QoL, quantitative measures alone may be insufficient to capture the impact on QoL. This thesis supports the conclusion that QoL benefits may be observed in association with CSII therapy. Both qualitative and quantitative studies demonstrate improved QoL (e.g. increased independence, freedom and flexibility, particularly in terms of meal timing and content) for CSII users (measured using a range of generic, health related and diabetes-specific measures). These findings are consistent for children, adolescents and adults using CSII. In addition, Chapters 4 and 6 report QoL benefits for members of the family as well as the individual with diabetes. Specific life domains important for QoL cited by children and adolescents are consistent with those in the literature, i.e. ‘family’, ‘friends’ and ‘school’, while parents most frequently cited ‘health’, ‘family’ and ‘work’ as important for their QoL. All domains were rated as better since commencement of CSII therapy. Future research needs to focus on identifying the factors that predict success using CSII therapy and the individuals who would most be suited to benefit from using CSII therapy.