Health outcomes and value orientation—a case study in diabetic patients with retinopathy or neuropathy

Values influence social activities and social decisions, but the interaction of values and health outcomes (HO), which are of increasing importance for evidence-based medicine and public health decisions, has not been analysed so far and was the objective of this study.

This case study used the social value scale which assigns individual human beings into stable and clearly separated value orientation (VO) groups. For the first time an attempt was made to investigate the VO and the HO of patients and relate them to different aspects of their diabetic complications neuropathy or retinopathy, disease patterns with a wide range of disease burden ranging from minor symptoms to severe burden such as blindness or amputation.

Physician visits, costs and the physical component health-related quality of life (HRQL) were highly dependent on the complication type, with retinopathy patients having fewer visits at the treating physician, more visits at other physicians, lower costs from the GKV (gesetzliche Krankenkasse = compulsory health insurance fund) and societal perspectives, and a higher physical HRQL. In contrast, the amount of glycosylated haemoglobin (HbA1c) and the mental component HRQL were significantly influenced by the VO: active Realists, who comprised the largest VO group among the patients with diabetic complications, exhibited the lowest HbA1c and accounted for the highest percentage of working patients, indicating that they manage their disease more efficiently than other VO groups. In the retinopathy sample the active realists also had the highest mental HRQL. In contrast, the conventionalists had the smallest proportion of working patients and exhibited the highest HbA1c, indicating that they did not manage their disease effectively; in the retinopathy sample, the conventionalists had the lowest mental HRQL.

Thus, values might influence both individual treatment decisions and the perception of the disease in general and could thus provide additional insight into future investigations of HO.