Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges

Table 2 Studies assess the effect of insulin therapy on satisfaction and quality of life

Effect on QOL	Comparison	PROMs	Result	Ref.
Negative	Insulin vs non-insulin users at baseline	SF-12v2; ADDQoL	Stable insulin treatment was associated with worse health status and QOL in comparison to non-insulin users	[123]
	Insulin vs non-insulin users at baseline and after 1 year	DHP; Rand-36	Insulin users had more significant problems in social functioning, pain and mental state than non-insulin users	[166]
	Insulin vs non-insulin users	SF-36v.2; WHOQOL-BREF	Insulin treated patients were associated with lower mental score than non-insulin users with no significant difference in other domains	[180]
	Insulin vs non-insulin users	DQOL; Rosser index	Individuals with established insulin therapy showed lower satisfaction and QOL	[123]
	Insulin vs non-insulin users	EQ5D; DTSQ	Insulin treatment was associated with lower HRQOL and treatment satisfaction scores than non-insulin treatment	[136]
	Insulin vs non-insulin users	SF-36	Insulin users had worse vitality and physical function domains than non-insulin users	[125]
	Insulin vs non-insulin users	EQ-5D	Insulin users had lower HRQOL scores than those not using any therapies	[126]
	Insulin vs non-insulin users	ADDQOL	Insulin therapy was associated with lower QOL scores	[181]
	Insulin vs non-insulin users	SF-12	Insulin was associated with significant lower HRQOL scores (especially mental composite scores)	[174]
	Insulin vs non-insulin users	SF-36; DHP	Insulin users showed lower scores in six domains of SF-36 questionnaire (physical functioning, social functioning, role physical, mental health, vitality, and general health) and in 2 domains of DHP-1 (barriers to activity and psychological distress) than non-insulin users	[175]
	Insulin vs non-insulin users	DQOLBCI; PDDT; QOL-VAS	Insulin therapy was associated with lower overall QOL scores (especially pain associated with treatment scale)	[182]
	Insulin vs non-insulin users	ADDQOL	Insulin use was associated with lower scores of QOL especially in younger patients	[131]
	Insulin vs non-insulin users	SF-36; HADS	Insulin therapy negatively affected emotional state, bodily pain, and physical state	[176]
	Insulin vs non-insulin users	ADDQOL-18	Insulin use was associated with negative impact on QOL	[183]
	Insulin vs non-insulin users	EQ-5D-5L; SF-12; EQ-5D-3L	Insulin users experienced more issues in self-care and usual activities, while individuals receiving combination therapy of insulin and oral drugs encountered greater difficulties in mobility, pain/discomfort, and anxiety/depression domains	[184]
	Insulin vs non-insulin users	SF-36; HADS; COPM; VAS-P; IPAQ	Insulin users exhibited more significant impairments in quality of life, functional capacity, and socialization, while also reporting higher levels of neuropathic pain and symptoms of anxiety and depression compared to non-insulin users	[127]
	Retrospective comparison	EQ-5D-5L	Longer duration of insulin use was associated with lower scores of QOL	[185]
Positive	Baseline vs follow up for 4 years of insulin therapy	SF-12v2; ADDQOL	Initiation of insulin therapy did not significantly affect health status or QOL during 4 years of follow up	[123]
	Baseline vs 4-8 wk short course of intensive insulin therapy	SF-36; DQOL; DSC-R	Early initiation of a short course of intensive insulin Therapy (IIT) associated with increased satisfaction and QOL	[129]
	Baseline vs one year of insulin treatment	DHP; Rand-36	Significant improvements in psychological distress and disinhibited eating scores of DHP questionnaire. Also, scores of vitality, physical function, social functioning and health change domain related to Rand-36 showed significant improvements	[166]
	Insulin vs non-insulin users	SF-36	Insulin users showed better quality of life in 2 domains (physical and emotional) out of 8 domains compared to non-insulin users	[167]
	Baseline vs 4 and 12 wk for insulin and non-insulin users	SF-36; DTSQ; GDS; GHQ-28	Insulin was associated with improvement in QOL, treatment satisfaction and mood reflected in different domains (Mental Health-Vitality-Social functioning-Role emotional and physical)	[133]
	Baseline vs 6 months of follow up	SF-36; DTSQ; HADS	Significant improvement in health status of Basal/Bolus group over time (7 domains) and in comparison, to oral medication group (vitality, social function, and mental health domains). Also, Basal/Bolus showed improvement in depression scores (first 3 months) and anxiety. Treatment satisfaction improved in all groups	[134]
	Baseline vs 6 months of follow up	HFS-w; DSC-R; WHO-5; ITAS	Significant improvement of well-being and QOL especially vitality and general mood	[168]
	Insulin (analog vs human) ± OAD vs OAD alone	DAWN QOL	Insulin users showed higher scores related to diet compliance and 3 subscales related to QOL measurements in comparison to non-insulin users	[169]
	Baseline vs 18 months of insulin initiation or switching	EQ-VAS; PITQ; EITQ	Improvement of the patients’ satisfaction to insulin and QOL scores in comparison to baseline	[170,171]
	Baseline vs one year of follow up	SF-36v2; DQOLCTQ	Scores of treatment satisfaction, diabetes impact and worry improved over time for each group with no significant difference between them	[172]
	Baseline vs 12 vs 24 wk for insulin users and non-insulin-users	DTSQ; ADDQOL	Significant improvement of treatment satisfaction and QOL for insulin group better than oral antidiabetic group	[135]
	Baseline vs 24 wk after insulin initiation or insulin switching	EQ-5D	Significant improvements in all measured 5 domains (Mobility- Pain/discomfort-Anxiety/depression-Self-Care-Usual activities) related to QOL for both insulin naïve and experienced patients	[164]
	Baseline vs 24 wk after insulin initiation or insulin switching	EQ-5D	Significant improvement in 3 domains (Mobility-Pain/discomfort-Anxiety/depression) out of 5 domains related to QOL for both insulin naïve and experienced patients	[165]

ADDQOL: Audit of diabetes dependent quality of life;COPM: Canadian occupational performance measure; DAWN QOL: Diabetes attitudes, wishes, and needs quality of life; DHP: Diabetes health profile; DQOL: Diabetes quality of life questionnaire; DQOLBCI: Diabetes quality of life brief clinical inventory; DQOLCTQ: Diabetes quality of life clinical trial questionnaire; DSC-R: Diabetes symptom checklist-revised; DTSQ: Diabetes treatment satisfaction questionnaire; EITQ: Expectations about insulin therapy questionnaire; EQ-5D: Euro quality of life-5 dimension; EQ-5D-3L: Euro quality of life-5 dimension-3 levels; EQ-5D-5L: Euro quality of life-5 dimension-5 levels; EQ-VAS: Euro quality of life visual analogue scale; GHQ-28: General health questionnaire-28 items; GDS: Geriatric depression scale; HADS: Hospital anxiety and depression scale; HFS-W: Worry subscale of the hypoglycemia fear survey; HRQOL: Health-related quality of life; IPAQ: International physical activity questionnaire; ITAS: Insulin treatment appraisal scale; PDDT: Patient-perceived difficulties in diabetes treatment; PITQ: Patients' perceptions of insulin therapy questionnaire; PROMs: Patient-reported outcome measures; QOL-VAS: Quality of life-visual analogue scale; SF-12: Short form 12-items; SF-12v2: Short form 12 version 2; SF-36: Short form 36-items; SF-36v.2: Short form 36-items questionnaire version 2; VAS-P: Visual analogue scale of pain; WHO-5: World Health Organization-5 wellbeing index; WHOQOL-BREF: World Health Organization quality of life brief version.