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SEARCH for Diabetes in Youth Study

Michelle J. Naughton, PhD, MPH; Andrea M. Ruggiero, MS; Jean M. Lawrence, ScD, MPH, MSSA; Giuseppina Imperatore, MD, PhD; Georgeanna J. Klingensmith, MD; Beth Waitzfelder, PhD; Robert E. McKeown, PhD; Debra A. Standiford, RN, MSN, CNP; Angela D. Liese, PhD, MPH; Beth Loots, MPH, MSW; for the SEARCH for Diabetes in Youth Study Group

Arch Pediatr Adolesc Med. 2008;162(7):649-657.

Objective  To examine the associations between demographic and diabetes management variables and the health-related quality of life (HRQOL) of youths with type 1 or type 2 diabetes mellitus (DM).

Design  Cross-sectional study.

Settings  Selected populations in Ohio, Washington, South Carolina, Colorado, Hawaii, and California; health service beneficiaries in 3 American Indian populations; and participants in the Pima Indian Study in Arizona.

Participants  Two thousand four hundred forty-five participants aged 8 to 22 years in the SEARCH for Diabetes in Youth Study.

Main Outcome Measure  Pediatric Quality of Life Inventory scores.

Results  Among youths with type 2 DM, HRQOL was lower compared with those with type 1. Among those with type 1 DM, worse HRQOL was associated with a primary insurance source of Medicaid or another government-funded insurance, use of insulin injections vs an insulin pump, a hemoglobin A_1c value of at least 9%, and more comorbidities and diabetes complications. There was a significant age x sex interaction, such that, in older groups, HRQOL was lower for girls but higher for boys. For youths with type 2 DM, injecting insulin at least 3 times a day compared with using an oral or no diabetes medication was associated with better HRQOL, and having 2 or more emergency department visits in the past 6 months was associated with worse HRQOL.

Conclusions  Youths with types 1 and 2 DM reported HRQOL differences by type of treatment and complications. The significant age x sex interaction suggests that interventions to improve HRQOL should consider gender differences in diabetes adjustment and management in different age groups.

Author Affiliations: Departments of Social Sciences and Health Policy (Dr Naughton) and Biostatistical Sciences (Ms Ruggiero), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Research and Development, Kaiser Permanente Southern California, Pasadena (Dr Lawrence); Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Imperatore); Barbara Davis Center, University of Colorado School of Medicine, Denver (Dr Klingensmith); Pacific Health Research Institute, Honolulu, Hawaii (Dr Waitzfelder); Department of Epidemiology and Biostatistics, University of South Carolina, Columbia (Drs McKeown and Liese); Division of Endocrinology, Children's Hospital Medical Center, Cincinnati, Ohio (Ms Standiford); and Endocrinology, Children's Hospital and Regional Medical Center, Seattle, Washington (Ms Loots).

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