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


METHODS
The 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.


RESULTS
The 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.


CONCLUSIONS
We concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes.
Maddigan
Sheri L
SL
Institute of Health Economics, Edmonton, AB, Canada. maddigan@ualberta.ca
Majumdar
Sumit R
SR
Toth
Ellen L
EL
Feeny
David H
DH
Johnson
Jeffrey A
JA
D000368:Aged; D000704:Analysis of Variance; D017281:Cost of Illness; D003627:Data Interpretation, Statistical; D003924:Diabetes Mellitus, Type 2 / Q000145:classification* / Q000523:psychology / Q000628:therapy; D005260:Female; D006302:Health Services Research / Q000379:methods; D006304:Health Status; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D007004:Hypoglycemic Agents; D007328:Insulin