title: Health-related quality of life for pre-diabetic states and type 2 diabetes mellitus: a cross-sectional study in Västerbotten Sweden.
abstract: BACKGROUND
  Type 2 diabetes (T2D) decreases health-related quality of life, but there is a lack of information about the health status of people in pre-diabetic states. However, information on health utility weights (HUWs) for pre-diabetic states and T2D are essential to estimate the effect of prevention initiatives. We estimated and compared HUWs for healthy individuals, those with pre-diabetes and those with T2D in a Swedish population and evaluated the influence of age, sex, education and body mass index on HUWs.
  
  
  METHODS
  Participants of the Västerbotten Intervention Program, Sweden, between 2002 and 2012, who underwent an oral glucose tolerance test or indicated they had T2D and who filled in the Short Form-36 questionnaire (SF-36) were included. Individuals were categorized as healthy, being in any of three different pre-diabetic states, or as T2D. The pre-diabetic states are impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or a combination of both (IFG&IGT). The SF-6D index was used to convert SF-36 responses to HUWs. HUWs were stratified by age, sex, education and body mass index. Beta regression analyses were conducted to estimate the effect of multiple risk factors on the HUWs.
  
  
  RESULTS
  In total, 55 882 individuals were included in the analysis. The overall mean HUW was 0.764. The mean HUW of healthy individuals was 0.768, 0.759 for those with IFG, 0.746 for those with IGT, 0.745 for those with IFG&IGT, and 0.738 for those with T2D. In the overall model, all variables except underweight vs. normal weight were significantly associated with HUW. Younger age, male sex, and higher education were associated with increased HUW. Normal weight, or being overweight was associated with elevated HUW, while obesity was associated with lower HUW.
  
  
  CONCLUSIONS
  Healthy individuals had higher HUWs than participants with T2D, while individuals with IFG, IGT or IFG&IGT had HUWs that ranged between those for NGT and T2D. Therefore, preventing the development of pre-diabetic states would improve health-related quality of life in addition to lowering the risk of developing T2D.
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden. anne.neumann@uniklinikum-dresden.de.|Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. anne.neumann@uniklinikum-dresden.de.
authors.forename: Anne
authors.initials: A
authors.lastname: Neumann
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. olaf.schoffer@uniklinikum-dresden.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: Schoffer
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden. fredrik.norstrom@epiph.umu.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Norström
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden. margareta.norberg@epiph.umu.se.
authors.forename: Margareta
authors.initials: M
authors.lastname: Norberg
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. stefanie.klug@uniklinikum-dresden.de.
authors.forename: Stefanie J
authors.initials: SJ
authors.lastname: Klug
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden. lars.lindholm@epiph.umu.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Lindholm
mesh_terms: D000328:Adult; D001786:Blood Glucose; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000523:psychology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000453:epidemiology* / Q000523:psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
chemical_list: D001786:Blood Glucose