title: Coping with Type II diabetes: the patient's perspective.
abstract: OBJECTIVE
  The Cost of Diabetes in Europe-Type II study is the first coordinated attempt to assess the total costs of Type II (non-insulin-dependent) diabetes mellitus in Europe. Although gaining a clearer understanding of the economics of diabetes was the goal of the study, a secondary objective was to consider the impact of Type II diabetes from the patient's perspective.
  
  
  METHODS
  The protocol included a health status questionnaire completed by the patient, the EQ-5D instrument, which assessed health-related quality of life by asking the patient to consider five dimensions: mobility, self-care, usual activities, pain and discomfort, as well as anxiety and depression.
  
  
  RESULTS
  A total of 4189 patients in five of the eight countries completed the EQ-5D questionnaire for assessing the quality of life. Overall, patients with Type II diabetes reported scores between good and fair states of health, although the average score (0.69) was lower than that of the similarly aged, healthy population in the United Kingdom. However, these values were higher (0.76) in Type II diabetic patients without complications. The onset of either microvascular or macrovascular complications adversely affected quality of life (0.69 and 0.69, respectively), and the presence of both types of complications further reduced the quality of life score to 0.59. Treatment with insulin was also associated with a reduced quality of life (0.62). Multivariate analysis showed that the following factors, in order of importance, independently pre-dict a poorer quality of life: gender, complications, treatment type, age, obesity and hyperglycaemia.
  
  
  CONCLUSIONS
  The results showed that health-related quality of life is an important issue in Type II diabetes and this decreases with disease progression. The implication for policy-makers is that reducing or preventing the complications of diabetes is the key to improving patient quality of life.
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. koopmanschap@bmg.eur.nl.
authors.forename: M
authors.initials: M
authors.lastname: Koopmanschap
keywords: CODE-2; Type II diabetes; quality of life