title: Health related quality of life, reoperation rate and function in patients with diabetes mellitus and hip fracture--a 2 year follow-up study.
abstract: BACKGROUND
  Diabetes mellitus confers an increased risk of hip fractures. There is a limited knowledge of how the outcome after a hip fracture in patients with diabetes affect Health Related Quality of Life (HRQoL). The primary aim of this study was to evaluate HRQoL. Secondary aims were reoperation rate, complications and functions in patients with diabetes followed for 2 years after a hip fracture.
  
  
  METHODS
  Out of 2133 patients diabetes was present in 234 patients (11%). Main outcome measurements were HRQoL evaluated with EuroQoL 5-Dindex score, reoperation rate, surgical and medical complications, function as walking ability, daily activities, living condition and pain.
  
  
  RESULTS
  Preoperatively, patients with diabetes mellitus had more pain (p=0.044), co-morbidities, reduced health status (p=0.001) and more often used a walking frame (p=0.014) than patients without diabetes, whereas Katz ADL index, cognition and body mass index did not differ. There was no difference in fracture type, surgical method or reoperation between the two groups or between patients with insulin treated or oral treated diabetes. The EQ-5Dindex score decreased from 0.64 at admission to 0.45 at 4 months, 0.49 at 12 months and 0.51 at 24 months with similar results for patients with and without diabetes. During the first postoperative year there was not more medical complications among patients with diabetes, however cardiac (p=0.023) and renal failure (p=0.032) were more frequent in patients with diabetes at 24 months. Patients with diabetes more often had severe hip pain at 4 months (p=0.031). At 12 months more diabetic patients were living independently (p=0.034). There was no difference in walking ability, ADL and living condition between the groups at 24 months.
  
  
  CONCLUSIONS
  The findings of this study indicate that patients with diabetes mellitus had more pain, co-morbidities, reduced health status preoperatively than patients without diabetes. Hip fracture patients with diabetes mellitus have more hip pain at 4 months. Cardiac and renal failure was more frequent in patients with diabetes at 24 months but otherwise we found a comparable re-operation rate, function and deterioration of Health Related Quality of Life as patients without diabetes within 2 years after a hip fracture.
authors.affiliation: Karolinska Institutet, Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital Solna, Stockholm, Sweden. wilhelmina.ekstrom@karolinska.se
authors.forename: W
authors.initials: W
authors.lastname: Ekström
authors.forename: A N
authors.initials: AN
authors.lastname: Al-Ani
authors.forename: M
authors.initials: M
authors.lastname: Sääf
authors.forename: T
authors.initials: T
authors.lastname: Cederholm
authors.forename: S
authors.initials: S
authors.lastname: Ponzer
authors.forename: M
authors.initials: M
authors.lastname: Hedström
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods* / Q000401:mortality; D006620:Hip Fractures / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D016138:Walking