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Published in: Health and Quality of Life Outcomes 1/2019

Open Access 01-12-2019 | Type 2 Diabetes | Research

Health-related quality of life and glycaemic control among adults with type 1 and type 2 diabetes – a nationwide cross-sectional study

Authors: Maria Svedbo Engström, Janeth Leksell, Unn-Britt Johansson, Sixten Borg, Bo Palaszewski, Stefan Franzén, Soffia Gudbjörnsdottir, Katarina Eeg-Olofsson

Published in: Health and Quality of Life Outcomes | Issue 1/2019

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Abstract

Background

Health-related quality of life and glycaemic control are some of the central outcomes in clinical diabetes care and research. The purpose of this study was to describe the health-related quality of life and assess its association with glycaemic control in adults with type 1 and type 2 diabetes in a nationwide setting.

Methods

In this cross-sectional survey, people with type 1 (n = 2479) and type 2 diabetes (n = 2469) were selected at random without replacement from the Swedish National Diabetes Register. Eligibility criteria were being aged 18–80 years with at least one registered test of glycated haemoglobin (HbA1c) the last 12 months. The generic 36-item Short Form version 2 (SF-36v2) was answered by 1373 (55.4%) people with type 1 diabetes and 1353 (54.8%) with type 2 diabetes.

Results

Correlation analyses showed weak correlations between scores on the SF-36v2 and glycaemic control for both diabetes types. After the participants were divided into three groups based on their levels of HbA1c, multivariate regression analyses adjusted for demographics, other risk factors and diabetes complications showed that among participants with type 1 diabetes, the high-risk group (≥70 mmol/mol/8.6%) had statistically significantly lower means in five out of eight domains of the SF-36v2 and the mental component summary measure, as compared with the well-controlled group (< 52 mmol/mol/6.9%). Among the participants with type 2 diabetes, the high-risk group had the lowest statistically significantly means in seven domains and both summary measures.

Conclusions

Among people with type 1 and type 2 diabetes, adults with high-risk HbA1c levels have lower levels of health-related quality of life in most but not all domains of the SF-36v2. This finding was not explained by demographics, other risk factors, or diabetes complications. The weak individual-level correlations between HRQOL scores and levels of glycaemic control argues for the need to not focus exclusively on either HbA1c levels or HRQOL scores but rather on both because both are important parts of a complex, life-long, challenging condition.
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Literature
1.
go back to reference Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial Care for People with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40.CrossRef Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial Care for People with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40.CrossRef
2.
go back to reference Fisher L, Tang T, Polonsky W. Assessing quality of life in diabetes: I. a practical guide to selecting the best instruments and using them wisely. Diabetes Res Clin Pract. 2017;126:278–85.CrossRef Fisher L, Tang T, Polonsky W. Assessing quality of life in diabetes: I. a practical guide to selecting the best instruments and using them wisely. Diabetes Res Clin Pract. 2017;126:278–85.CrossRef
3.
go back to reference Polonsky WH. Emotional and quality-of-life aspects of diabetes management. Curr Diab Rep. 2002;2(2):153–9.CrossRef Polonsky WH. Emotional and quality-of-life aspects of diabetes management. Curr Diab Rep. 2002;2(2):153–9.CrossRef
4.
go back to reference Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999;15(3):205–18.CrossRef Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999;15(3):205–18.CrossRef
5.
go back to reference Luscombe FA. Health-related quality of life measurement in type 2 diabetes. Value Health. 2000;3(Suppl 1):15–28.CrossRef Luscombe FA. Health-related quality of life measurement in type 2 diabetes. Value Health. 2000;3(Suppl 1):15–28.CrossRef
6.
go back to reference American Diabetes Association. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S34–45.CrossRef American Diabetes Association. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S34–45.CrossRef
7.
go back to reference American Diabetes Association. 5. Lifestyle management: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S46–60.CrossRef American Diabetes Association. 5. Lifestyle management: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S46–60.CrossRef
8.
go back to reference American Diabetes Association. 6. Glycemic targets: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S61–70.CrossRef American Diabetes Association. 6. Glycemic targets: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S61–70.CrossRef
9.
go back to reference Norris SL, McNally TK, Zhang X, Burda B, Chan B, Chowdhury FM, et al. Published norms underestimate the health-related quality of life among persons with type 2 diabetes. J Clin Epidemiol. 2011;64(4):358–65.CrossRef Norris SL, McNally TK, Zhang X, Burda B, Chan B, Chowdhury FM, et al. Published norms underestimate the health-related quality of life among persons with type 2 diabetes. J Clin Epidemiol. 2011;64(4):358–65.CrossRef
10.
go back to reference Speight J, Reaney MD, Barnard KD. Not all roads lead to Rome—a review of quality of life measurement in adults with diabetes. Diabet Med. 2009;26:315–27.CrossRef Speight J, Reaney MD, Barnard KD. Not all roads lead to Rome—a review of quality of life measurement in adults with diabetes. Diabet Med. 2009;26:315–27.CrossRef
12.
go back to reference Hart HE, Bilo HJ, Redekop WK, Stolk RP, Assink JH, Meyboom-de JB. Quality of life of patients with type I diabetes mellitus. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2003;12(8):1089–97. Hart HE, Bilo HJ, Redekop WK, Stolk RP, Assink JH, Meyboom-de JB. Quality of life of patients with type I diabetes mellitus. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2003;12(8):1089–97.
13.
go back to reference Lloyd CE, Orchard TJ. Physical and psychological well-being in adults with type 1 diabetes. Diabetes Res Clin Pract. 1999;44(1):9–19.CrossRef Lloyd CE, Orchard TJ. Physical and psychological well-being in adults with type 1 diabetes. Diabetes Res Clin Pract. 1999;44(1):9–19.CrossRef
14.
go back to reference de Visser CL, Bilo HJ, Groenier KH, de Visser W, Jong M-d B. The influence of cardiovascular disease on quality of life in type 2 diabetics. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2002;11(3):249–61. de Visser CL, Bilo HJ, Groenier KH, de Visser W, Jong M-d B. The influence of cardiovascular disease on quality of life in type 2 diabetics. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2002;11(3):249–61.
15.
go back to reference Kalda R, Ratsep A, Lember M. Predictors of quality of life of patients with type 2 diabetes. Patient Prefer Adherence. 2008;2:21–6.PubMedPubMedCentral Kalda R, Ratsep A, Lember M. Predictors of quality of life of patients with type 2 diabetes. Patient Prefer Adherence. 2008;2:21–6.PubMedPubMedCentral
16.
go back to reference Kleefstra N, Ubink-Veltmaat LJ, Houweling ST, Groenier KH, Meyboom-de Jong B, Bilo HJ. Cross-sectional relationship between glycaemic control, hyperglycaemic symptoms and quality of life in type 2 diabetes (ZODIAC-2). Neth J Med. 2005;63(6):215–21.PubMed Kleefstra N, Ubink-Veltmaat LJ, Houweling ST, Groenier KH, Meyboom-de Jong B, Bilo HJ. Cross-sectional relationship between glycaemic control, hyperglycaemic symptoms and quality of life in type 2 diabetes (ZODIAC-2). Neth J Med. 2005;63(6):215–21.PubMed
17.
go back to reference Kuznetsov L, Griffin SJ, Davies MJ, Lauritzen T, Khunti K, Rutten GE, et al. Diabetes-specific quality of life but not health status is independently associated with glycaemic control among patients with type 2 diabetes: a cross-sectional analysis of the ADDITION-Europe trial cohort. Diabetes Res Clin Pract. 2014;104(2):281–7.CrossRef Kuznetsov L, Griffin SJ, Davies MJ, Lauritzen T, Khunti K, Rutten GE, et al. Diabetes-specific quality of life but not health status is independently associated with glycaemic control among patients with type 2 diabetes: a cross-sectional analysis of the ADDITION-Europe trial cohort. Diabetes Res Clin Pract. 2014;104(2):281–7.CrossRef
18.
go back to reference Lloyd A, Sawyer W, Hopkinson P. Impact of long-term complications on quality of life in patients with type 2 diabetes not using insulin. Value Health. 2001;4(5):392–400.CrossRef Lloyd A, Sawyer W, Hopkinson P. Impact of long-term complications on quality of life in patients with type 2 diabetes not using insulin. Value Health. 2001;4(5):392–400.CrossRef
19.
go back to reference Nicolucci A, Cucinotta D, Squatrito S, Lapolla A, Musacchio N, Leotta S, et al. Clinical and socio-economic correlates of quality of life and treatment satisfaction in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis. 2009;19(1):45–53.CrossRef Nicolucci A, Cucinotta D, Squatrito S, Lapolla A, Musacchio N, Leotta S, et al. Clinical and socio-economic correlates of quality of life and treatment satisfaction in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis. 2009;19(1):45–53.CrossRef
20.
go back to reference Weinberger M, Kirkman MS, Samsa GP, Cowper PA, Shortliffe EA, Simel DL, et al. The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus. Med Care. 1994;32(12):1173–81.CrossRef Weinberger M, Kirkman MS, Samsa GP, Cowper PA, Shortliffe EA, Simel DL, et al. The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus. Med Care. 1994;32(12):1173–81.CrossRef
21.
go back to reference Larsson D, Lager I, Nilsson PM. Socio-economic characteristics and quality of life in diabetes mellitus--relation to metabolic control. Scand J Public Health. 1999;27(2):101–5.CrossRef Larsson D, Lager I, Nilsson PM. Socio-economic characteristics and quality of life in diabetes mellitus--relation to metabolic control. Scand J Public Health. 1999;27(2):101–5.CrossRef
22.
go back to reference Nerenz DR, Repasky DP, Whitehouse FW, Kahkonen DM. Ongoing assessment of health status in patients with diabetes mellitus. Med Care. 1992;30(5 Suppl):MS112–24.PubMed Nerenz DR, Repasky DP, Whitehouse FW, Kahkonen DM. Ongoing assessment of health status in patients with diabetes mellitus. Med Care. 1992;30(5 Suppl):MS112–24.PubMed
23.
go back to reference Woodcock AJ, Julious SA, Kinmonth AL, Campbell MJ. Diabetes care from diagnosis group. Problems with the performance of the SF-36 among people with type 2 diabetes in general practice. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2001;10(8):661–70. Woodcock AJ, Julious SA, Kinmonth AL, Campbell MJ. Diabetes care from diagnosis group. Problems with the performance of the SF-36 among people with type 2 diabetes in general practice. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2001;10(8):661–70.
24.
go back to reference Fitzpatrick R, Bowling A, Gibbons E, Haywood K, Jenkinson C, Mackintosh A, et al. A structured review of patient-reported measures in relation to selected chronic conditions, perceptions of quality of care and carer impact National Centre for health outcomes development (Oxford site): unit of health-care epidemiology. Oxford: Department of Public Health, University of Oxford; 2006. Fitzpatrick R, Bowling A, Gibbons E, Haywood K, Jenkinson C, Mackintosh A, et al. A structured review of patient-reported measures in relation to selected chronic conditions, perceptions of quality of care and carer impact National Centre for health outcomes development (Oxford site): unit of health-care epidemiology. Oxford: Department of Public Health, University of Oxford; 2006.
25.
go back to reference Gibbons E, Fitzpatrick R. Patient reported outcome measurement group. Oxford: A structured review of patient-reported outcome measures (PROMs) for diabetes: University of Oxford; 2009. Gibbons E, Fitzpatrick R. Patient reported outcome measurement group. Oxford: A structured review of patient-reported outcome measures (PROMs) for diabetes: University of Oxford; 2009.
26.
go back to reference Kleefstra N, Landman GW, Houweling ST, Ubink-Veltmaat LJ, Logtenberg SJ, Meyboom-de Jong B, et al. Prediction of mortality in type 2 diabetes from health-related quality of life (ZODIAC-4). Diabetes Care. 2008;31(5):932–3.CrossRef Kleefstra N, Landman GW, Houweling ST, Ubink-Veltmaat LJ, Logtenberg SJ, Meyboom-de Jong B, et al. Prediction of mortality in type 2 diabetes from health-related quality of life (ZODIAC-4). Diabetes Care. 2008;31(5):932–3.CrossRef
27.
go back to reference Landman GW, van Hateren KJ, Kleefstra N, Groenier KH, Gans RO, Bilo HJ. Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18). Diabetes Care. 2010;33(11):2378–82.CrossRef Landman GW, van Hateren KJ, Kleefstra N, Groenier KH, Gans RO, Bilo HJ. Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18). Diabetes Care. 2010;33(11):2378–82.CrossRef
28.
go back to reference Bjorner JB, Lyng Wolden M, Gundgaard J, Miller KA. Benchmarks for interpretation of score differences on the SF-36 health survey for patients with diabetes. Value Health. 2013;16(6):993–1000.CrossRef Bjorner JB, Lyng Wolden M, Gundgaard J, Miller KA. Benchmarks for interpretation of score differences on the SF-36 health survey for patients with diabetes. Value Health. 2013;16(6):993–1000.CrossRef
29.
go back to reference American Diabetes Association. 7. Diabetes technology: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S71–80.CrossRef American Diabetes Association. 7. Diabetes technology: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S71–80.CrossRef
30.
go back to reference American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S90–S102.CrossRef American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S90–S102.CrossRef
31.
go back to reference Borg S, Eeg-Olofsson K, Palaszewski B, Svedbo Engstrom M, Gerdtham UG, Gudbjornsdottir S. Patient-reported outcome and experience measures for diabetes: development of scale models, differences between patient groups and relationships with cardiovascular and diabetes complication risk factors, in a combined registry and survey study in Sweden. BMJ Open. 2019;9(1):e025033.CrossRef Borg S, Eeg-Olofsson K, Palaszewski B, Svedbo Engstrom M, Gerdtham UG, Gudbjornsdottir S. Patient-reported outcome and experience measures for diabetes: development of scale models, differences between patient groups and relationships with cardiovascular and diabetes complication risk factors, in a combined registry and survey study in Sweden. BMJ Open. 2019;9(1):e025033.CrossRef
32.
go back to reference Svedbo Engstrom M, Leksell J, Johansson UB, Eeg-Olofsson K, Borg S, Palaszewski B, et al. A disease-specific questionnaire for measuring patient-reported outcomes and experiences in the Swedish National Diabetes Register: development and evaluation of content validity, face validity, and test-retest reliability. Patient Educ Couns. 2018;101(1):139–46.CrossRef Svedbo Engstrom M, Leksell J, Johansson UB, Eeg-Olofsson K, Borg S, Palaszewski B, et al. A disease-specific questionnaire for measuring patient-reported outcomes and experiences in the Swedish National Diabetes Register: development and evaluation of content validity, face validity, and test-retest reliability. Patient Educ Couns. 2018;101(1):139–46.CrossRef
33.
go back to reference Maruish ME. User’s manual for the SF-36v2 health survey. 3rd ed. Lincoln: QualityMetric Incorporated; 2011. Maruish ME. User’s manual for the SF-36v2 health survey. 3rd ed. Lincoln: QualityMetric Incorporated; 2011.
34.
35.
go back to reference Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643–53.CrossRef Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643–53.CrossRef
36.
go back to reference American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S103–S23.CrossRef American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S103–S23.CrossRef
37.
go back to reference American Diabetes Association. 11. Microvascular complications and foot care: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S124–S38.CrossRef American Diabetes Association. 11. Microvascular complications and foot care: standards of medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S124–S38.CrossRef
38.
go back to reference Nair R, Kachan P. Outcome tools for diabetes-specific quality of life: study performed in a private family practice clinic. Can Fam Physician. 2017;63(6):e310–e5.PubMedPubMedCentral Nair R, Kachan P. Outcome tools for diabetes-specific quality of life: study performed in a private family practice clinic. Can Fam Physician. 2017;63(6):e310–e5.PubMedPubMedCentral
39.
go back to reference Svedbo Engström M, Leksell J, Johansson U-B, Gudbjörnsdottir S. What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored patient-reported outcome measure for the Swedish National Diabetes Register. BMJ Open. 2016;6(3):e010249.CrossRef Svedbo Engström M, Leksell J, Johansson U-B, Gudbjörnsdottir S. What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored patient-reported outcome measure for the Swedish National Diabetes Register. BMJ Open. 2016;6(3):e010249.CrossRef
Metadata
Title
Health-related quality of life and glycaemic control among adults with type 1 and type 2 diabetes – a nationwide cross-sectional study
Authors
Maria Svedbo Engström
Janeth Leksell
Unn-Britt Johansson
Sixten Borg
Bo Palaszewski
Stefan Franzén
Soffia Gudbjörnsdottir
Katarina Eeg-Olofsson
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2019
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-019-1212-z

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