title: Comorbidity, health-related quality of life and self-care in type 2 diabetes: a cross-sectional study in an outpatient population.
abstract: BACKGROUND
  Comorbid conditions may be related (concordant) or unrelated (discordant) to diabetes. Comorbidity in patients with type 2 diabetes (T2DM) is associated with reduced health-related quality of life (HRQoL) and self-care.
  
  
  OBJECTIVE
  To examine the impact of comorbidity on HRQoL and self-care in T2DM patients attending an outpatient setting.
  
  
  METHODS
  A cross-sectional questionnaire was sent to 498 patients with T2DM, aged 25-80 years, previously attending (August 2011-July 2012) an outpatient diabetes service in a Dublin hospital. The EuroQoL-5 Dimension (EQ-5D) and a modified summary of diabetes self-care activities scale were used to assess HRQoL and self-care, respectively. Comorbidity was assessed using a simplified version of the self-administered comorbidity Questionnaire. Mann-Whitney and Kruskal-Wallis tests were used to examine the association between EQ-5D index scores or self-care, and the number and type of comorbidities. Multiple linear regression, adjusting for age and sex, was used to examine the association between EQ-5D score, comorbidity score and type.
  
  
  RESULTS
  EQ-5D scores decreased with an increasing number of comorbidities and with discordant comorbidity (P = 0.0001). Comorbidity type was associated with physical activity. The highest level of physical activity was reported in respondents with no comorbidity (median 4.5 IQR 3-6), while the lowest was in patients with both concordant and discordant comorbidity (median 2.5 IQR 0-5).
  
  
  CONCLUSIONS
  Health professionals should be aware of the fall in HRQoL associated with comorbidity. This should be taken into account in the management of patients. Patients with discordant comorbidity should be advised and supported to maintain levels of physical activity.
authors.affiliation: Department of Pharmacology and Therapeutics, Trinity Centre for Health Science, St James's Hospital, Trinity College Dublin, Dublin 8, Ireland, osheami@tcd.ie.
authors.forename: M P
authors.initials: MP
authors.lastname: O'Shea
authors.forename: M
authors.initials: M
authors.lastname: Teeling
authors.forename: K
authors.initials: K
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires