UMMS Affiliation

Department of Quantitative Health Sciences

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Clinical Epidemiology | Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Epidemiology | Health Services Administration | Immune System Diseases | Nutritional and Metabolic Diseases | Pediatrics


Introduction: To achieve optimized blood glucose concentrations (assessed by HbA1c) and high health-related quality of life (HRQL), children and adolescents with diabetes mellitus type 1 (T1DM) must follow strict disease management strategies. This study aims to investigate HRQL of children and adolescents with T1DM and its association with HbA1c values over the course of 6 months.

Methods: Patients aged 7-17 years (n = 203) with T1DM provided HRQL data on a monthly basis. HRQL was measured using the Kids-CAT, a computer-adaptive test (CAT) comprising five generic HRQL domains. HbA1c concentrations were assessed at baseline, at 3 and 6 months. We explored the trajectory of HRQL at the domain level using linear mixed effects models. Further, we investigated the association between HRQL and HbA1c concentrations over time using path analysis models.

Results: Children and adolescents with T1DM reported high scores across all HRQL domains over time. However, those with an HbA1c concentrations of > 9.0% reported significantly lower scores in physical well-being and parent relations compared with those with an HbA1c concentration of < 7.5%. Path analysis models revealed a minimal temporal relationship between HbA1c and HRQL, with a small negative impact of HbA1c on physical well-being, psychological well-being and parent relations.

Conclusion: Although observed HRQL of young patients with T1DM was comparable to age-related German-speaking reference population over the course of 6 months, those with an HbA1c concentration > 9.0% reported lower scores in selected HRQL domains. Thus, special attention should be drawn to HRQL of children and adolescents with higher HbA1c concentrations. The minimal relationship between HbA1c and HRQL indicates that the two therapy goals, i.e., achievement and maintenance of glycemic targets and high HRQL, should be considered and evaluated independently in clinical routine.

Trial Registration: DRKS00006326 (German Clinical Trial Register), date of registration: August 1st, 2014.


computer-adaptive testing, diabetes mellitus type 1, health-related quality of life, patient outcome assessments, pediatrics, self-report

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Copyright © 2020 Fischer, Fischer, Barthel, Otto, Thyen, Klein, Walter, Ravens-Sieberer, Rose and Nolte. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

DOI of Published Version



Fischer KI, Fischer FH, Barthel D, Otto C, Thyen U, Klein M, Walter O, Ravens-Sieberer U, Rose M, Nolte S. Trajectories of Health-Related Quality of Life and HbA1c Values of Children and Adolescents With Diabetes Mellitus Type 1 Over 6 Months: A Longitudinal Observational Study. Front Pediatr. 2020 Jan 21;7:566. doi: 10.3389/fped.2019.00566. PMID: 32039122; PMCID: PMC6986264. Link to article on publisher's site

Journal/Book/Conference Title

Frontiers in pediatrics

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.