© 2008 The Authors. Journal compilation © 2008 Diabetes UK. Diabetic Medicine, 25, 213–220 213 DIABETICMedicine DOI: 10.1111/j.1464-5491.2007.02346.x Blackwell Publishing Ltd Original Article: Education/Psychological Issues Original article Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections The EQuality1 Study Group—evaluation of QUALITY of life and costs in diabetes Type 1. Writing committee: A. Nicolucci*, A. Maione*, M. Franciosi*, R. Amoretti†, E. Busetto‡, F. Capani§, D. Bruttomesso¶, P. Di Bartolo**, A. Girelli††, F. Leonetti‡‡, L. Morviducci§§, P. Ponzi‡ and E. Vitacolonna§ *Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, (CH), †The Diabetes Unit, Azienda Ospedaliera S. Giovanni Addolorata, Rome, ‡Fondazione Medtronic Italia, Sesto San Giovanni (MI) , §Department of Medicine and Ageing, University ‘G. D’Annunzio’, Chieti and Online University ‘Leonardo da Vinci’, Torrevecchia Teatina (CH), ¶Department of Clinical and Experimental Medicine, University of Padova, Padova, **Diabetes Unit, AUSL Provincia di Ravenna, Ravenna, ††Diabetes Unit, Spedali Civili di Brescia, Brescia, ‡‡Department of Clinical Sciences, La Sapienza University and §§Diabetes Unit, San Camillo Hospital, Rome, Italy Accepted 5 September 2007 Abstract Aims The aim of this case–control study was to compare quality of life (QoL) and treatment satisfaction in adults with Type 1 diabetes (T1DM) treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Methods Consecutive patients aged between 18 and 55 years, and attending diabetes clinics for a routine visit, completed the Diabetes-Specific Quality-of-Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the SF-36 Health Survey (SF-36). Case (CSII) and control subjects (MDI) were recruited in a 1 : 2 ratio. Results Overall, 1341 individuals were enrolled by 62 diabetes clinics; 481 were cases and 860 control subjects. Cases had a longer diabetes duration and were more likely to have eye and renal complications. Age, school education, occupation and HbA 1c were similar. Of control subjects, 90% followed glargine-based MDI regimens and 10% used NPH-based MDI regimens. On multivariate analysis, after adjusting for socioeconomic and clinical characteristics, scores in the following areas of the DSQOLS were higher in cases than control subjects: diet restrictions (β = 5.96; P < 0.0001), daily hassles (β = 3.57; P = 0.01) and fears about hypoglycaemia (β = 3.88; P = 0.006). Treatment with CSII was also associated with a markedly higher DTSQ score (β = 4.13; P < 0.0001) compared with MDI. Results were similar when CSII was compared separately with glargine- or NPH-based MDI regimens. Conclusions This large, non-randomized, case–control study suggests quality of life gains deriving from greater lifestyle flexibility, less fear of hypoglycaemia, and higher treatment satisfaction, when CSII is compared with either glargine-based or NPH-based MDI regimens. Diabet. Med. 25, 213–220 (2008) Keywords continuous subcutaneous insulin infusion, multiple daily injections, quality of life, questionnaires, Type 1 diabetes Abbreviations CI, confidence interval; CSII, continuous subcutaneous insulin injection; DSQOLS, Diabetes-Specific Quality-of-Life Scale; DTSQ, Diabetes Treatment Satisfaction Questionnaire; MDI, multiple daily injections; OR, odds ratio; QoL, quality of life; SF-36, SF-36 Health Survey; T1DM, Type 1 diabetes Correspondence to: Antonio Nicolucci, MD, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro (CH), Italy. E-mail: nicolucci@negrisud.it