Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2013

Open Access 01-12-2013 | Research

Health-related quality of life associated with daytime and nocturnal hypoglycaemic events: a time trade-off survey in five countries

Authors: Marc Evans, Kamlesh Khunti, Muhammad Mamdani, Claus B Galbo-Jørgensen, Jens Gundgaard, Mette Bøgelund, Stewart Harris

Published in: Health and Quality of Life Outcomes | Issue 1/2013

Login to get access

Abstract

Background

Hypoglycaemic events, particularly nocturnal, affect health-related quality of life (HRQoL) via acute symptoms, altered behaviour and fear of future events. We examined the respective disutility associated with a single event of daytime, nocturnal, severe and non-severe hypoglycaemia.

Methods

Representative samples were taken from Canada, Germany, Sweden, the United States and the United Kingdom. Individuals completed an internet-based questionnaire designed to quantify the HRQoL associated with different diabetes- and/or hypoglycaemia-related health states. HRQoL was measured on a utility scale: 1 (perfect health) to 0 (death) using the time trade-off method. Three populations were studied: 8286 respondents from the general population; 551 people with type 1 diabetes; and 1603 with type 2 diabetes. Respondents traded life expectancy for improved health states and evaluated the health states of well-controlled diabetes and diabetes with non-severe/severe and daytime/nocturnal hypoglycaemic events.

Results

In the general population, non-severe nocturnal hypoglycaemic events were associated with a 0.007 disutility compared with 0.004 for non-severe daytime episodes, equivalent to a significant 63% increase in negative impact. Severe daytime and nocturnal events were associated with a 0.057 and a 0.062 disutility, respectively, which were not significantly different.

Conclusions

This study applies an established health economic methodology to derive disutilities associated with hypoglycaemia stratified by onset time and severity using a large multinational population. It reveals substantial individual and cumulative detrimental effects of hypoglycaemic events – particularly nocturnal – on HRQoL, reinforcing the clinical imperative of avoiding hypoglycaemia.
Appendix
Available only for authorised users
Literature
1.
Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, Band MM, Reekie G, Leese GP, DARTS/MEMO Collaboration: Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. Diabet Med 2005, 22: 749–755. 10.1111/j.1464-5491.2005.01501.xPubMedCrossRef
2.
3.
Workgroup on Hypoglycemia. ADA: Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care 2005, 28: 1245–1249.CrossRef
4.
Yale J-F, Begg I, Gerstein H, Houlden R, Jones H, Maheux P, Pacaud D: 2001 Canadian diabetes association clinical practice guidelines for the prevention and management of hypoglycemia in diabetes. Can J Diabetes 2001, 28: 22–35.
5.
Hepburn DA: Symptoms of hypoglycemia. In Hypoglycemia and diabetes: clinical and physiological aspects. Edited by: Frier BM. London: Edward Arnold; 1993.
6.
Alvarez-Guisasola F, Yin DD, Nocea G, Qiu Y, Mavros P: Association of hypoglycemic symptoms with patients’ rating of their health-related quality of life state: a cross sectional study. Health Qual Life Outcomes 2010, 8: 86. 10.1186/1477-7525-8-86PubMedCentralPubMedCrossRef
7.
Brod M, Christiansen T, Thomsen TL, Bushnell DM: The impact of non-severe hypoglycaemic events on work productivity and diabetes management. Value Health 2011, 14: 665–671. 10.1016/j.jval.2011.02.001PubMedCrossRef
8.
Polonsky WH, Davis CL, Jacobson AM, Anderson BJ: Correlates of hypoglycemic fear in type I and type II diabetes mellitus. Health Psychol 1992, 11: 199–202.PubMedCrossRef
9.
Green AJ, Fox KM, Grandy S, SHIELD Study Group: Self-reported hypoglycemia and impact on quality of life and depression among adults with type 2 diabetes mellitus. Diabetes Res Clin Pract 2012, 96: 313–318. 10.1016/j.diabres.2012.01.002PubMedCrossRef
10.
Barendse S, Singh H, Frier BM, Speight J: The impact of hypoglycaemia on quality of life and related patient-reported outcomes in Type 2 diabetes: a narrative review. Diabet Med 2012, 29: 293–302. 10.1111/j.1464-5491.2011.03416.xPubMedCrossRef
11.
Graveling AJ, Frier BM: Impaired awareness of hypoglycaemia: a review. Diabetes Metab 2010, 36: S64-S74.PubMedCrossRef
12.
Clarke P, Gray A, Holman R: Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making 2002, 22: 340–349.PubMedCrossRef
13.
14.
Davis RE, Morrissey M, Peters JR, Wittrup-Jensen K, Kennedy-Martin T, Currie CJ: Impact of hypoglycaemia on quality of life and productivity in type 1 and type 2 diabetes. Curr Med Res Opin 2005, 21: 1477–1483. 10.1185/030079905X61929PubMedCrossRef
15.
Lundkvist J, Berne C, Bolinder B, Jonsson L: The economic and quality of life impact of hypoglycaemia. Eur J Health Econ 2005, 6: 197–202. 10.1007/s10198-005-0276-3PubMedCrossRef
16.
Currie CJ, Morgan CL, Poole CD, Sharplin P, Lammert M, McEwan P: Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med Res Opin 2006, 22: 1523–1534. 10.1185/030079906X115757PubMedCrossRef
17.
Matza LS, Boye KS, Yurgin N, Brewster-Jordan J, Mannix S, Shorr JM, Barber BL: Utilities and disutilities for type 2 diabetes treatment-related attributes. Qual Life Res 2007, 16: 1251–1265. 10.1007/s11136-007-9226-0PubMedCrossRef
18.
Levy AR, Christensen TL, Johnson JA: Utility values for symptomatic non-severe hypoglycaemia elicited from persons with and without diabetes in Canada and the United Kingdom. Health Qual Life Outcomes 2008, 6: 73. 10.1186/1477-7525-6-73PubMedCentralPubMedCrossRef
19.
Torrance GW, Furlong W, Feeny D: Health utility estimation. Expert Rev Pharmacoecon Outcomes Res 2002, 2: 99–108. 10.1586/14737167.2.2.99PubMedCrossRef
20.
Torrance GW, Blaker D, Detsky A, Kennedy W, Schubert F, Menon D, Tugwell P, Konchak R, Hubbard E, Firestone T: Canadian guidelines for economic evaluation of pharmaceuticals. Canadian Collaborative Workshop for Pharmacoeconomics. Pharmacoeconomics 1996, 9: 535–539.PubMed
21.
22.
Dolan P, Gudex C, Kind P, Williams A: The time trade-off method: results from a general population study. Health Econ 1996, 5: 141–154. 10.1002/(SICI)1099-1050(199603)5:2<141::AID-HEC189>3.0.CO;2-NPubMedCrossRef
23.
Dolan P: Modeling valuations for EuroQol health states. Med Care 1997, 35: 1095–1108. 10.1097/00005650-199711000-00002PubMedCrossRef
24.
Dolan P, Jones-Lee M: The time trade-off: a note on the effect of lifetime reallocation of consumption and discounting. J Health Econ 1997, 16: 731–739. 10.1016/S0167-6296(96)00514-0PubMedCrossRef
25.
Dolan P: The measurement of individual utility and social welfare. J Health Econ 1998, 17: 39–52. 10.1016/S0167-6296(97)00022-2PubMedCrossRef
26.
Robinson A, Dolan P, Williams A: Valuing health status using VAS and TTO: what lies behind the numbers? Soc Sci Med 1997, 45: 1289–1297. 10.1016/S0277-9536(97)00057-9PubMedCrossRef
27.
Torrance GW, Feeny D: Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989, 5: 559–575. 10.1017/S0266462300008461PubMedCrossRef
28.
Torrance GW: Preferences for health outcomes and cost-utility analysis. Am J Manag Care 1997,3(Suppl 1):S8-S20.PubMed
29.
Dolan P: Aggregating health state valuations. J Health Serv Res Policy 1997, 2: 160–165.PubMed
30.
31.
Szende A, Brazier J, Schaefer C, Deuson R, Isitt JJ, Vyas P: Measurement of utility values in the UK for health states related to immune thrombocytopenic purpura. Curr Med Res Opin 2010, 26: 1893–1903. 10.1185/03007995.2010.494126PubMedCrossRef
32.
Lieu TA, Ray GT, Ortega-Sanchez IR, Kleinman K, Rusinak D, Prosser LA: Willingness to pay for a QUALY based on community member and patient preferences for temporary health states associated with herpes zoster. PharmacoEconomics 2009, 27: 1005–1016. 10.2165/11314000-000000000-00000PubMedCrossRef
33.
Chang WT, Collins ED, Kerrigan CL: An Internet-based utility assessment of breast hypertrophy. Plast Reconstr Surg 2001, 108: 370–377. 10.1097/00006534-200108000-00014PubMedCrossRef
34.
Hurley J: An overview of the normative economics of the health sector. Chapter 2. In Cost-effectiveness in Health and Medicine. Edited by: Gold MR, Siegel JE, Russell LB, Weinstein MC. New York: Oxford University Press, Inc.; 1996:62–67.
35.
Dolan P: The measurement of health-related quality of life for use in resource allocation decisions in health care. Chapter 32. In Handbook of Health Economics. Edited by: Culyer AJ, Newhouse JP. Amsterdam: Elsevier (North Holland Publishing Co.); 2000:1738–1740.
36.
Gold MR, Patrick DL, Torrance GW, Fryback DG, Hadorn DC, Kamlet MS, Daniels N, Weinstein MC: Identifying and Valuing Outcomes. Chapter 4. In Cost-effectiveness in Health and Medicine. Edited by: Gold MR, Siegel JE, Russell LB, Weinstein MC. New York: Oxford University Press, Inc.; 1996:105–106.
37.
Briggs AH, Wonderling DE, Mooney CZ: Pulling cost-effectiveness up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 1997, 6: 327–340. 10.1002/(SICI)1099-1050(199707)6:4<327::AID-HEC282>3.0.CO;2-WPubMedCrossRef
38.
Atkinson SE, Wilson PW: Comparing mean efficiency and productivity scores from small samples: a bootstrap methodology. J Prod Anal 1995, 6: 137–152. 10.1007/BF01073408CrossRef
39.
Efron B: Nonparametric estimates of standard error: the jackknife, the bootstrap and other methods. Biometrika 1981, 68: 589–599. 10.1093/biomet/68.3.589CrossRef
40.
Attema AE, Brouwer WB: The value of correcting values: influence and importance of correcting TTO scores for time preference. Value Health 2010, 13: 879–884. 10.1111/j.1524-4733.2010.00773.xPubMedCrossRef
41.
42.
Fidler C, Elmelund Christensen T, Gillard S: Hypoglycaemia: an overview of fear of hypoglycaemia, quality-of-life, and impact on costs. J Med Econ 2011, 14: 646–655. 10.3111/13696998.2011.610852PubMedCrossRef
43.
Jaeschke R, Singer J, Guyatt GH: Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989, 10: 407–415. 10.1016/0197-2456(89)90005-6PubMedCrossRef
44.
Revicki DA, Cella D, Hays RD, Sloan JA, Lenderking WR, Aaronson NK: Responsiveness and minimal important differences for patient reported outcomes. Health Qual Life Outcomes 2006, 4: 70. 10.1186/1477-7525-4-70PubMedCentralPubMedCrossRef
45.
Luo N, Johnson JA, Coons SJ: Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Med Care 2010, 48: 365–371. 10.1097/MLR.0b013e3181c162a2PubMedCrossRef
46.
Pickard AS, Maureen P, Neary MP, Cella D: Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health Qual Life Outcomes 2007, 5: 70. 10.1186/1477-7525-5-70PubMedCentralPubMedCrossRef
47.
Walters SJ, Brazier JE: What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health Qual Life Outcomes 2003, 1: 4. 10.1186/1477-7525-1-4PubMedCentralPubMedCrossRef
48.
Drummond M: Introducing economic and quality of life measurements into clinical studies. Ann Med 2001, 33: 344–349. 10.3109/07853890109002088PubMedCrossRef
Metadata
Title
Health-related quality of life associated with daytime and nocturnal hypoglycaemic events: a time trade-off survey in five countries
Authors
Marc Evans
Kamlesh Khunti
Muhammad Mamdani
Claus B Galbo-Jørgensen
Jens Gundgaard
Mette Bøgelund
Stewart Harris
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2013
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/1477-7525-11-90

Other articles of this Issue 1/2013

Health and Quality of Life Outcomes 1/2013 Go to the issue

Review

Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain

Research

Posttraumatic stress symptoms after solid-organ transplantation: preoperative risk factors and the impact on health-related quality of life and life satisfaction

Research

Health literacy and ethnic disparities in health-related quality of life among rural women: results from a Chinese poor minority area

Research

Overall mental distress and health-related quality of life after solid-organ transplantation: results from a retrospective follow-up study

Research

Indigenous injury outcomes: life satisfaction among injured Māori in New Zealand three months after injury

Research

Do generic utility measures capture what is important to the quality of life of people with multiple sclerosis?