Abstract
BackgroundType 2 diabetes (T2D) decreases health-related quality of life, but there is a lack of information about the health status of people in pre-diabetic states. However, information on health utility weights (HUWs) for pre-diabetic states and T2D are essential to estimate the effect of prevention initiatives. We estimated and compared HUWs for healthy individuals, those with pre-diabetes and those with T2D in a Swedish population and evaluated the influence of age, sex, education and body mass index on HUWs.MethodsParticipants of the Västerbotten Intervention Program, Sweden, between 2002 and 2012, who underwent an oral glucose tolerance test or indicated they had T2D and who filled in the Short Form-36 questionnaire (SF-36) were included. Individuals were categorized as healthy, being in any of three different pre-diabetic states, or as T2D. The pre-diabetic states are impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or a combination of both (IFG&IGT). The SF-6D index was used to convert SF-36 responses to HUWs. HUWs were stratified by age, sex, education and body mass index. Beta regression analyses were conducted to estimate the effect of multiple risk factors on the HUWs.ResultsIn total, 55 882 individuals were included in the analysis. The overall mean HUW was 0.764. The mean HUW of healthy individuals was 0.768, 0.759 for those with IFG, 0.746 for those with IGT, 0.745 for those with IFG&IGT, and 0.738 for those with T2D. In the overall model, all variables except underweight vs. normal weight were significantly associated with HUW. Younger age, male sex, and higher education were associated with increased HUW. Normal weight, or being overweight was associated with elevated HUW, while obesity was associated with lower HUW.ConclusionsHealthy individuals had higher HUWs than participants with T2D, while individuals with IFG, IGT or IFG&IGT had HUWs that ranged between those for NGT and T2D. Therefore, preventing the development of pre-diabetic states would improve health-related quality of life in addition to lowering the risk of developing T2D.
Highlights
Type 2 diabetes (T2D) decreases health-related quality of life, but there is a lack of information about the health status of people in pre-diabetic states
The majority was categorized as normal glucose tolerant (NGT) (n = 43 586, 78.0%), while 5 629 individuals had impaired fasting glucose (IFG) (10.1%), 2 440 impaired glucose tolerance (IGT) (4.4%), 1 232 IFG&IGT (2.2%) and 2 995 T2D (5.4%)
Principal findings We found that participants with NGT had higher health utility weight” (HUW) than those with T2D, while those with IFG, IGT or a combination of both had HUWs that ranged between those for NGT and T2D
Summary
Type 2 diabetes (T2D) decreases health-related quality of life, but there is a lack of information about the health status of people in pre-diabetic states. We estimated and compared HUWs for healthy individuals, those with pre-diabetes and those with T2D in a Swedish population and evaluated the influence of age, sex, education and body mass index on HUWs. Type 2 diabetes mellitus (T2D) is a severe disease with an estimated number of cases exceeding 370 million globally and 390 000 in Sweden in 2012 [1]. T2D and pre-diabetic states can be detected using a standardized oral glucose tolerance test and medical classifications, such as those of the World Health Organization [5]. According to this classification of blood glucose levels, a person can be categorized as normal glucose tolerant (NGT), i.e. healthy, being in a pre-diabetic state, or as having T2D. Subjects in any of these three pre-diabetic states have moderate to severe insulin resistance, impaired insulin secretion and/or insulin sensitivity, and each state has distinct pathophysiologic etiologies and risks of developing into T2D [6,7]
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