Abstract
BackgroundType 2 diabetes (T2D) causes significant health and economic burden. In addition to comorbidities there are also coexisting diseases linked to obesity, lifestyle and T2D. The aim of this study was to examine the effect of T2D and T2D-coexisting diseases on health-related quality of life (HRQoL) in the Finnish population and whether it is T2D or the coexisting diseases that have the largest impact on HRQoL.MethodsThe study was based on a national cross-sectional population survey (n = 5305). Respondents’ HRQoL was measured using the EQ-5D-5 L instrument. Our study included diabetic respondents treated with non-insulin medications (NI-T2D) with or without insulin and non-diabetic respondents, whereas diabetic respondents not taking any anti-diabetic medications or treated with insulin alone were excluded. A crosswalk algorithm was used to convert EQ-5D-5 L index scores into EQ-5D-3 L index scores as a sensitivity analysis. A two-part model was used to examine the association between T2D and coexisting diseases and HRQoL.ResultsThe unadjusted mean (SD) EQ-5D-5 L index scores for non-diabetics (n = 4856) was 0.90 (0.13) and 0.85 (0.16) for respondents with NI-T2D (n = 449). With adjustment for demographic factors, the difference in EQ-5D-5 L index scores was 0.036 (95% CI 0.023–0.050). After adjusting for the number of coexisting diseases, the EQ-5D-5 L index scores among respondents with NI-T2D and three or more coexisting diseases were lower when compared to all non-diabetics but not when compared to non-diabetics with similar number of coexisting diseases. The number of T2D-coexisting diseases had a larger effect on EQ-5D-5 L index scores in younger age groups (20 and 40 years old).ConclusionsLower EQ-5D-5 L index score is associated with NI-T2D when compared to non-diabetic respondents. When compared to non-diabetics, the disutility associated with NI-T2D increases as more coexisting diseases appear. The disutility effect of coexisting diseases was equally large in non-diabetics and respondents with NI-T2D. Thus, public health interventions targeting the prevention of both T2D and its coexisting diseases have potential to have significant benefits also in terms of HRQoL.
Highlights
Type 2 diabetes (T2D) causes significant health and economic burden
Results from the anxiety/depression and self-care dimensions did not differ between respondents with non-insulin treated T2D (NI-T2D) and non-diabetics
The development of a Finnish value set would increase the validity of results in health-related quality of life (HRQoL) studies conducted in the Finnish population. Both unadjusted and adjusted EQ-5D-5 L index scores were lower among respondents with NI-T2D compared to non-diabetics
Summary
Type 2 diabetes (T2D) causes significant health and economic burden. The prevalence of lifestyle-related non-communicable diseases is increasing rapidly in many high-income countries; including Finland [1]. Increasing prevalence of overweight and obesity, arising from energy-rich diets and sedentary lifestyles, is driving this growth [2]. Overweight and obesity are significant risk factors for T2D [3] and many other prevalent diseases, including hypertension, cancer, arthritis, obstructive sleep apnea, and gall bladder disease [4]. There is an interest to examine the connections between obesity, type 2 diabetes (T2D) and its coexisting diseases. Diabetes causes a considerable disease burden with an estimated 425 million adults having diabetes in 2017, carrying along a major economic burden [5]. The estimated cost of T2D was 1.5 billion euros in Finland in 2011 [8]
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