QUALITY OF LIFE AMONG TYPE 1 DIABETIC PATIENTS TREATED WITH NEUTRAL PROTAMINE HAGEDORN (NPH) INSULIN REGIMEN

Abstract

Background: Type 1 Diabetes Mellitus (T1DM) requires lifelong insulin therapy for survival, glycemic control and prevention of acute and chronic complications. Neutral Protamine Hagedorn (NPH) insulin remains widely used in low- and middle-income countries because of its affordability and availability. NPH insulin has a peak action profile and may be associated with hypoglycemia, glycemic variability, treatment burden and reduced health-related quality of life. Objective: This study aimed to assess quality of life parameters among patients with T1DM receiving NPH insulin in Pakistan. Materials and Methods: This NPH-only analysis included 90 patients with confirmed T1DM receiving NPH insulin. Demographic and clinical characteristics, glycemic control, hypoglycemia frequency and severity, medication adherence, adverse drug reactions, SF-36 quality of life domains and Diabetes Quality of Life (DQOL) scores were analyzed descriptively. Continuous variables were reported as mean ± standard deviation while categorical variables were presented as frequency and percentage. No comparison with other insulin regimens was included. Results: The mean age of NPH users was 27.5 ± 9.2 years and the mean duration of diabetes was 8.2 ± 5.1 years. Mean HbA1c was 8.2 ± 1.1%, fasting blood glucose was 165 ± 30 mg/dL and postprandial blood glucose was 240 ± 40 mg/dL. Follow-up HbA1c was 7.9 ± 0.9%. Hypoglycemia was common, with 39% reporting 1–2 episodes/month and 28% reporting ≥3 episodes/month. Severe hypoglycemia occurred in 24% of patients. The overall SF-36 score was 60.2 ± 9.1 while the overall DQOL score was 62.0 ± 8.6. The lowest quality of life scores was observed in the social domains. Conclusion: T1DM patients receiving NPH insulin in Pakistan showed moderate quality of life, suboptimal glycemic control, frequent hypoglycemia and variable adherence. Routine quality of life assessment, hypoglycemia prevention and structured patient education should be integrated into care for NPH-treated T1DM patients.