Health-related quality of life in adolescents with or at risk for type 2 diabetes mellitus.
OBJECTIVE
To evaluate how adolescents with or at risk for type 2 diabetes mellitus (T2DM) and their parent/guardians (parents) perceive adolescents' health-related quality of life.


METHODS
We interviewed overweight/obese, 12- to 18-year-old youth with T2DM, prediabetes, or insulin resistance and one parent from 5 US sites. Assessments included Pediatric Quality of Life Inventory (PedsQL), Health Utilities Index, family conflict, and diabetes burden.


RESULTS
In 108 adolescents, diagnoses included 40.7% with T2DM, 25.0% with prediabetes, and 34.3% with insulin resistance. PedsQL summary score (SS) was higher in adolescents than parents (P=.02). Parents rated physical functioning lower than adolescents (P<.0001), but there were no differences in psychosocial health. Adolescent PedsQL SS did not differ with diagnosis, but was inversely associated with adolescent body mass index z-score (P=.0004) and family conflict (P<.0001) and associated with race/ethnicity (P<.0001). Number of adolescent co-morbidities (P=.007) and burden of diabetes care (P<.05) were inversely associated with parent PedsQL SS. There were no differences in the Health Utilities Index-Mark 3 multi-attribute utility score.


CONCLUSIONS
Parents perceive their adolescents' physical functioning as more impaired than adolescents themselves. Contextual factors including severity of obesity, race/ethnicity, family conflict, and burden of diabetes care influence health-related quality of life. Family-based approaches to treatment and prevention of T2DM may benefit from increased attention to the biopsychosocial context.
Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA. Erinn.Rhodes@childrens.harvard.edu
Erinn T
ET
Rhodes
Michael I
MI
Goran
Tracy A
TA
Lieu
Robert H
RH
Lustig
Lisa A
LA
Prosser
Thomas J
TJ
Songer
Marc J
MJ
Weigensberg
Ruth S
RS
Weinstock
Tessa
T
Gonzalez
Kaitlin
K
Rawluk
Roula M
RM
Zoghbi
David S
DS
Ludwig
Lori M
LM
Laffel
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology