title: Obese versus non-obese patients with type 2 diabetes: patient-reported outcomes and utility of weight change.
abstract: BACKGROUND
  This study (1) used patient-reported outcome measures to assess and compare the health status of type 2 diabetes patients with and without obesity and (2) assessed the value of weight change among obese and non-obese subgroups, using standard gamble (SG) utility methodology.
  
  
  METHODS
  Among a sample with type 2 diabetes in the United Kingdom, individuals with obesity (BMI > or = 30 kg/m2) were identified and compared to non-obese patients. Patients completed the EQ-5D, Psychological General Well-Being Index, Appraisal of Diabetes Symptoms, and Diabetes Symptom Checklist-Revised (DSC-R). SG interviews assessed the utility of the 'basic' type 2 diabetes health state anchored to respondents' body weight, as well as health states with altered weight.
  
  
  RESULTS
  A total of 129 patients (74 obese; 55 non-obese) completed interviews (mean age 55.9 years; 64.3% male). Obese patients reported lower health status (EQ-5D VAS; between-group difference: p < 0.001) and greater symptom impact (several DSC-R scales, p < 0.05). Utilities of the basic health state were 0.86 (obese) and 0.91 (non-obese; p = 0.02). Hypothetical health states with higher weight received lower utilities, whereas reduced weight was associated with increased utility. There was a between-group difference in the disutility associated with 5% higher weight (obese 0.068; non-obese 0.051; p = 0.03).
  
  
  CONCLUSIONS
  Compared with non-obese patients, the obese group reported lower health status and greater symptom impact. SG interviews found an inverse relationship between weight and utility. Furthermore, obese patients with type 2 diabetes may value weight change differently than non-obese patients. Study limitations include the sample size and the use of a patient sample, rather than a sample selected from the general population. Overall, the results demonstrate that utilities can differ by patient subgroups, even among patients with the same diagnosis.
authors.affiliation: Center for Health Outcomes Research at UBC, Bethesda, MD 20814, USA. louis.matza@unitedbiosource.com
authors.forename: Louis S
authors.initials: LS
authors.lastname: Matza
authors.forename: Nicole
authors.initials: N
authors.lastname: Yurgin
authors.forename: Kristina S
authors.initials: KS
authors.lastname: Boye
authors.forename: Karen
authors.initials: K
authors.lastname: Malley
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Shorr
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D016896:Treatment Outcome