title: Preferences for type 2 diabetes health states among adolescents with or at risk of type 2 diabetes mellitus.
abstract: OBJECTIVE
  We evaluated how adolescents with or at risk of type 2 diabetes (T2DM) and their parent/guardians (parents) value health states associated with T2DM.
  
  
  METHODS
  We interviewed overweight/obese [Body Mass Index (BMI) ≥ 85th percentile], 12-18-yr old adolescents with T2DM, prediabetes, or insulin resistance (IR) and a parent. The standard gamble (SG) method elicited preferences (utilities) for seven hypothetical T2DM health states reported on a scale from 0 (dead) to 1 (perfect health). Adolescent's current health was evaluated with the SG and Health Utilities Index (HUI).
  
  
  RESULTS
  There were 70 adolescents and 69 parents. Adolescents were 67.1% female and 15.5 ± 2.2 yr old; 30% had T2DM, 30% prediabetes, and 40% IR. Almost half (48.6%) had a BMI > 99th percentile. Parents (83% mothers) were 45.1 ± 7.3 yr old and 75% had at least some college/technical school education. Adolescents and parents rated T2DM with no complications treated with diet as most desirable [median (IQR); adolescent 0.72 (0.54, 0.98); parent 1.0 (0.88, 1.0)] and end-stage renal disease as least desirable [adolescent 0.51 (0.31, 0.70); parent 0.80 (0.65, 0.94)]. However, adolescents' utilities were significantly lower (p ≤ 0.001) than parents for all health states assessed. Adolescents' assessments of their current health with the SG and HUI were not correlated.
  
  
  CONCLUSIONS
  Adolescents with or at risk of T2DM rated treatments and sequelae of diabetes as significantly worse than their parents. These adolescent utilities should be considered in the evaluation of treatment strategies for youth with T2DM. Family-based programs for T2DM must also be prepared to address conflicting preferences in order to promote shared decision-making.
authors.affiliation: Division of Endocrinology, Children's Hospital Boston, Boston, MA 02115, USA. Erinn.Rhodes@childrens.harvard.edu
authors.forename: Erinn T
authors.initials: ET
authors.lastname: Rhodes
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Songer
authors.forename: David S
authors.initials: DS
authors.lastname: Ludwig
authors.forename: Lori M
authors.initials: LM
authors.lastname: Laffel
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000523:psychology; D001294:Attitude to Health; D001766:Blindness / Q000209:etiology; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D005260:Female; D006304:Health Status; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D010290:Parents / Q000523:psychology*; D057240:Patient Preference; D018802:Patient-Centered Care; D011236:Prediabetic State / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012306:Risk
chemical_list: D007328:Insulin