title: Health-Related Quality of Life in Primary Care: Which Aspects Matter in Multimorbid Patients with Type 2 Diabetes Mellitus in a Community Setting?
abstract: OBJECTIVE
  Knowledge about predictors of health-related quality of life for multimorbid patients with type 2 diabetes mellitus in primary care could help to improve quality and patient-centeredness of care in this specific group of patients. Thus, the aim of this study was to investigate the impact of several patient characteristics on health-related quality of life of multimorbid patients with type 2 diabetes mellitus in a community setting.
  
  
  METHODS
  A cross-sectional study with 32 primary care practice teams in Mannheim, Germany, and randomly selected multimorbid patients with type 2 diabetes mellitus (N = 495) was conducted. In order to analyze associations of various patient characteristics with health-related quality of life (EQ-5D index) a multilevel analysis was applied.
  
  
  RESULTS
  After excluding patients with missing data, the cohort consisted of 404 eligible patients. The final multilevel model highlighted six out of 14 explanatory patient variables which were significantly associated with health-related quality of life: female gender (r = -0.0494; p = .0261), school education of nine years or less (r = -0.0609; p = .0006), (physical) mobility restrictions (r = -0.1074; p = .0003), presence of chronic pain (r = -0.0916; p = .0004), diabetes-related distress (r = -0.0133; p < .0001), and BMI (r = -0.0047; p = .0045).
  
  
  CONCLUSIONS
  The findings of this study suggest that increased diabetes-related distress, chronic pain, restrictions in (physical) mobility, female gender, as well as lower education and, increased BMI have a noteworthy impact on health-related quality of life in multimorbid patients with type 2 diabetes mellitus seen in primary care practices in a community setting. The highlighted aspects should gain much more attention when treating multimorbid patients with type 2 diabetes mellitus.
authors.affiliation: Department of General Practice and Health Services Research; University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Martina
authors.identifier: http://orcid.org/0000-0003-3603-5574
authors.initials: M
authors.lastname: Kamradt
authors.affiliation: Institute of Medical Biometry and Informatics; Department of Medical Biometry; University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Krisam
authors.affiliation: Department of General Practice and Health Services Research; University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Kiel
authors.affiliation: Department of General Practice and Health Services Research; University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Qreini
authors.affiliation: Genossenschaft Gesundheitsprojekt Mannheim e.G., Mannheim, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Besier
authors.affiliation: Department of General Practice and Health Services Research; University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.affiliation: Department of General Practice and Health Services Research; University Hospital Heidelberg, Heidelberg, Germany.|Department of Population Health Sciences, Health System Innovation and Research; University of Utah, Salt Lake City, UT, United States of America.
authors.forename: Dominik
authors.initials: D
authors.lastname: Ose
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D015992:Body Mass Index; D059350:Chronic Pain / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D003153:Community Health Services; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D018802:Patient-Centered Care; D011320:Primary Health Care; D011788:Quality of Life / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires