title: Health related quality of life and comorbidity. A descriptive analysis comparing EQ-5D dimensions of patients in the German disease management program for type 2 diabetes and patients in routine care.
abstract: BACKGROUND
  The co-occurance of multiple medical conditions has a negative impact on health related quality of life (HRQoL) for patients with type 2 diabetes. These patients demand for intensified care programs. Participation in a disease management program (DMP) for type 2 diabetes has shown to counterbalance this effect. However, it remains unclear which dimensions of HRQoL are influenced by the DMP. The aim of this study was to explore the HRQoL dimensions of patients with type 2 diabetes in the German DMP and patients in routine care (RC).
  
  
  METHODS
  This analysis is part of a comparative evaluation of the German DMP for patients with type 2 diabetes. A questionnaire, including the HRQoL measure EQ-5D, was mailed to a random sample of 3,546 patients with type 2 diabetes (59.3% female). The EQ-5D dimensions were analyzed by grouping patients according to their participation in the German DMP for diabetes into DMP and RC.
  
  
  RESULTS
  Compared to patients in DMP, patients in RC reported more problems for the dimensions mobility (P < 0.05), self care (P < 0.05) and performing usual activities (P < 0.01). Depending on the number of other conditions, remarkable differences for reporting "no problems" exist for patients with six or more comorbid conditions regarding the dimensions mobility (RC = 8.7%, DMP = 32.3%), self care (RC = 43.5%, DMP = 64.5%), usual activities (RC = 13.0%, DMP = 33.9%) and anxiety or depression (RC = 37.0%, DMP = 48.4%).
  
  
  CONCLUSIONS
  Patients participating in the German DMP for type 2 diabetes mellitus show significantly higher ratings of their HRQoL in the dimensions mobility, self care and performing usual activities compared to patients in RC. This difference can also be observed in patients with significant comorbidities. As these dimensions are known to be essential for diabetes care, the German DMP may contribute to improved care even for comorbid diabetes patients.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital of Heidelberg, Vosstrasse 2, D-69115 Heidelberg, Germany. dominik.ose@med.uni-heidelberg.de
authors.forename: Dominik
authors.initials: D
authors.lastname: Ose
authors.forename: Antje
authors.initials: A
authors.lastname: Miksch
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Urban
authors.forename: Iris
authors.initials: I
authors.lastname: Natanzon
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.forename: Cornelia Ursula
authors.initials: CU
authors.lastname: Kunz
authors.forename: Tobias
authors.initials: T
authors.lastname: Freund
mesh_terms: D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires