Health-related quality of life deficits associated with varying degrees of disease severity in type 2 diabetes

Sheri L Maddigan,David H Feeny,Jeffrey A Johnson,Ellen L Toth,Sumit R Majumdar

doi:10.1186/1477-7525-1-78

Abstract

BackgroundDiabetes is a chronic medical condition accompanied by a considerable health-related quality of life (HRQL) burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes.MethodsThe RAND-12 physical and mental health composites (PHC and MHC, respectively) and Health Utilities Index Mark 3 (HUI3) were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics.ResultsThe PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p < 0.05). Individuals treated with insulin had lower scores on the vision, emotion and pain attributes of the HUI3 than individuals managed with oral medication or diet. The PHC, MHC, pain attribute and overall score on the HUI3 captured substantial decrements in HRQL associated with absenteeism from work due to diabetes, while the burden associated with emergency room utilization for diabetes was seen in the PHC and HUI3 pain attribute.ConclusionsWe concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes.

Highlights

Diabetes is a chronic medical condition accompanied by a considerable healthrelated quality of life (HRQL) burden
For the variables used to separate the sample into known groups, individuals with missing Health Utilities Index Mark 3 (HUI3) scores tended to have more intensive treatment of their diabetes, i.e. they were more likely to use insulin and/or oral medications than to be managed on diet alone
We found the burden associated with severity of type 2 diabetes generally affected physical and mental dimensions of health status and HRQL, as measured by the RAND-12 and HUI3

Summary

Introduction

Diabetes is a chronic medical condition accompanied by a considerable healthrelated quality of life (HRQL) burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes. Severity of diabetes has been associated with increased burden and impairment on many dimensions of healthrelated quality of life (HRQL), including social functioning, cognition, role functioning, physical functioning, emotional well-being, general perceptions of health and (page number not for citation purposes). There is evidence that longer duration of diabetes is associated with deficits in HRQL [2,6,16,17], but some studies have failed to find this association [18,19]

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