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Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications

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Abstract

Objective: To measure subjective health-related quality of life (HRQoL) of patients with type 1 diabetes and describe the influence of symptoms of diabetes-related long-term complications on HRQoL. Methods: The 15-D health-related quality of life measure (15D) was used to measure HRQoL of a representative sample of Finnish insulin-treated patients expected to have type 1 diabetes. Background data were gathered with a separate questionnaire. A tobit (censored regression) model was constructed to estimate the effects of symptoms of complications on HRQoL and to separate these effects from those of other health problems and aging. Results: The 15D scores declined markedly with increasing age, and the prevalence of symptoms of long-term complications increased. The tobit regression model showed that these symptoms have a significant negative influence on HRQoL. The model explained over 50% of the variation in the 15D scores. Conclusions: High prevalence of symptoms of long-term complications combined with their significant negative influence on HRQoL causes substantial losses in terms of quality of life and utility from both individual and societal perspectives. Thus, the importance of secondary prevention, i.e., prevention of complications by better metabolic control, and also the so-far theoretic possibility to prevent type 1 diabetes itself is emphasized.

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References

  1. Brazier J, Deverill M, Green C, et al. A review of the use of health status measures in economic evaluation. Health Technol Assess 1999; 3.

  2. Karvonen M, Pitkäniemi J, Tuomilehto J, and The Finnish Childhood Diabetes Registry Group. The onset age oftype 1 diabetes in Finnish children has become younger. Diabet Care 1999; 22: 1066-1070.

    Google Scholar 

  3. Onkamo P, Väänänen S, Karvonen M, Tuomilehto J. Worldwide increase in incidence ofType I diabetes-the analysis of the data on published incidence trends. Diabetologia 1999; 42: 1395-1403.

    Google Scholar 

  4. Simell TT, Sintonen H, Hahl J, Simell OG. Costs ofinsulindependent diabetes mellitus. Pharmaco Economics 1996; 9: 24-38.

    Google Scholar 

  5. Lounamaa R. Mortality in Finnish Patients with Insulin-Dependent Diabetes Mellitus: A Follow-up Study of Patients Diagnosed when under Twenty Years of Age. ML: 126.Helsinki: Social Insurance Institution, Finland, 1993.

    Google Scholar 

  6. Borch-Johnsen K, Kreiner S, Deckert T. Mortality oftype 1 (insulin-dependent) diabetes mellitus in Denmark: A study ofrelative mortality in 2930 Danish type 1 diabetic patients diagnosed from 1933 to 1972. Diabetologia 1986; 29: 767-772.

    Google Scholar 

  7. Dorman JS, LaPorte RE, Kuller LH, et al. The Pittsburgh insulin-dependent diabetes mellitus (IDDM) morbidity and mortality study. Diabetes 1984; 33: 271-276.

    Google Scholar 

  8. Green A, Borch-Johnsen K, Andersen KP, Hougaard P, Keiding N, Deckert T. Relative mortality oftype 1 (insulindependent) diabetes in Denmark: 1933-1981. Diabetologia 1985; 28: 339-342.

    Google Scholar 

  9. Fryback DG, Lawrence WF, Martin PA, Klein R, Klein BE. Predicting Quality ofWell-being scores from the SF-36: Results from the Beaver Dam Health Outcomes Study. Med Decis Making 1997; 17: 1-9.

    Google Scholar 

  10. Hermann BP, Vickrey B, Hays J, et al. A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis. Epilepsy Res 1996; 25: 113-118.

    Google Scholar 

  11. Keinänen-Kiukaanniemi S, Ohinmaa A, Pajunpää P, Koivukangas P. Health related quality of life in diabetic patients measured by the Nottingham Health Profile. Diabet Med 1995; 13: 382-388.

    Google Scholar 

  12. Klein BEK, Klein R, Moss SE. Self-rated health and diabetes oflong duration. Diabet Care 1998; 21: 236-240.

    Google Scholar 

  13. The Diabetes Control and Complications Trial Research Group. Influence ofintensive diabetes treatment on qualityof-life outcomes in the diabetes control and complications trial. Diabet Care 1996; 19: 195-203.

    Google Scholar 

  14. Vickrey BG, Hays RD, Rausch R, et al. Quality of life of epilepsy patients as compared with outpatients with hy-pertension, diabetes, heart disease, and/or depressive symptoms. Epilepsia 1994; 35: 597-607.

    Google Scholar 

  15. Wändell PE, Brorsson B, Åberg H. Quality of life in diabetic patients registered with primary health care services in Sweden. Scand J Prim Health Care 1997; 15: 97-102.

    Google Scholar 

  16. Wikblad K, Leksell J, Wibell L. Health-related quality of life in relation to metabolic control and late complications in patients with insulin dependent diabetes mellitus. Qual Life Res 1996; 5: 123-130.

    Google Scholar 

  17. Wu S-Y, Sainfort F, Tomar RH et al. Development and application ofa model to estimate the impact oftype 1 diabetes on health-related quality of life. Diabet Care 1998; 21: 725-731.

    Google Scholar 

  18. Aalto A-M, Uutela A, Aro AR. Health related quality of life among insulin-dependent diabetics: disease-related and psychosocial correlates. Patient Educ Couns 1997; 30: 215-225.

    Google Scholar 

  19. Backonja M, Beydoun A, Edwards KR, et al. Gababentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998; 280: 1831-1836.

    Google Scholar 

  20. Gross CR, Zehrer CL. Health-related quality of life outcomes ofpancrea s transplant recipients. Clin Trasplant 1992; 6: 165-171.

    Google Scholar 

  21. Jacobson AM, de Groot M, Samson JA. The effects of psychiatric disorders and symptoms on quality of life in patients with type I and type II diabetes mellitus. Qual Life Res 1997; 6: 11-20.

    Google Scholar 

  22. Kiebert GM, van Oosterhout EC, van Bronswijk H, Lemkes HH, Gooszen HG. Quality of life after combined kidneypancreas or kidney transplantation in diabetic patients with end-stage renal disease. Clin Trasplant 1994; 8: 239-245.

    Google Scholar 

  23. Kohen D, Burgess AP, Catalan J, Lant A. The role of anxiety and depression in quality of life and symptom reporting in people with diabetes mellitus. Qual Life Res 1998; 7: 197-204.

    Google Scholar 

  24. Lloyd CE, Orchard TJ. Physical and psychosocial wellbeing in adults with Type 1 diabetes. Diabetes Res Clin Pract 1999; 44: 9-19.

    Google Scholar 

  25. Piehlmeier W, Bullinger M, Nusser J, et al. Quality of life in Type 1 (insulin-dependent) diabetic patients prior to and after pancreas and kidney transplantation in relation to organ function. Diabetologia 1991; 34: S150-S157.

    Google Scholar 

  26. Piehlmeier W, Bullinger M, Kirchberger I, Land W, Landgraf R. Evaluation of the quality of life of patients with insulin-dependent diabetes mellitus before and after organ transplantation with the SF 36 health survey. Eur J Surg 1996; 162: 933-940.

    Google Scholar 

  27. Bott U, Mühlhauser I, Overmann H, Berger M. Validation of a diabetes-specific quality-of-life scale for patients with type 1 diabetes. Diabet Care 1998; 21: 757-769.

    Google Scholar 

  28. Boyer JG, Earp JA. The development ofan instrument for assessing the quality of life ofpeople with diabetes. Med Care 1997; 35: 440-453.

    Google Scholar 

  29. Bradley C, Todd C, Gorton T, et al. The development ofan individualized questionnaire measure ofperceived inpact of diabetes on quality of life: the ADDQoL. Qual Life Res 1999; 8: 79-91.

    Google Scholar 

  30. Hammond GS, Aoki TT. Measurement of health status in diabetic patients. Diabetes impact measurement scales. Diabet Care 1992; 15: 469-477.

    Google Scholar 

  31. Jacobson AM, de Groot M, Samson JA. The evaluation of two measures of quality of life in patients with Type I and Type II diabetes. Diabet Care 1994; 17: 267-274.

    Google Scholar 

  32. Kotsanos JG, Vignati L, Huster W et al. Health-related quality-of-life results from multinational clinical trials of insulin lispro. Assessing benefits ofa new diabetes therapy. Diabet Care 1997; 20: 948-958.

    Google Scholar 

  33. Meadows K, Steen N, McColl E, et al. The Diabetes Health Profile (DHP): A new instrument for assessing the psychosocial profile ofinsulin requiring patients-development and psychometric evaluation. Qual Life Res 1996; 5: 242-254.

    Google Scholar 

  34. Arinen S, Häkkinen U, Klaukka T, Klavus J, Lehtonen R, Aro S. Health and the use of health Services in Finland. Official Statistics ofFinland. Health Care 1998: 5 Jyväskylä: Statistics Finland, 1998.

    Google Scholar 

  35. Sintonen H. The 15D instrument of health-relate d quality of life: properties and applications. Ann Med 2001; 33: 328-336. <http://www.annmed.org/annmed/articles/2001_33_5_328-36._pdf>.

    Google Scholar 

  36. Sintonen H. The 15-D measure of health-relate d quality of life: Reliability, validity and sensitivity of its health state descriptive system. Working Paper 41. Melbourne: National Centre for Health Program Evaluation, 1994. <http://chpe.buseco.monash.edu.au/pubs/wp41._pdf>.

    Google Scholar 

  37. Sintonen H. The 15-D measure of health-relate d quality of life: Feasibility, reliability and validity of its valuation system. Working Paper 42. Melbourne: National Centre for Health Program Evaluation, 1994. <http://chpe.buseco.-monash.edu.au/pubs/wp42._pdf>.

    Google Scholar 

  38. Nord E. Health status index models for use in resource allocation decisions: A critical review in the light ofobserved preferences for social choice. Int J Technol Assess Health Care 1996; 12: 31-44.

    Google Scholar 

  39. Stavem K. Reliability, validity and responsiveness oftwo multiattribute utility measures in patients with chronic obstructive pulmonary disease. Qual Life Res 1999; 8: 45-54.

    Google Scholar 

  40. Kannisto M, Sintonen H. Later health-related quality of life in adults who have sustained spinal cord injury in childhood. Spinal Cord 1997; 35: 747-751.

    Google Scholar 

  41. Kannisto M, Merikanto J, Alaranta H, Hokkanen H, Sintonen H. Comparison of health-relate d quality of life in three subgroups ofspinal cord injury patients. Spinal Cord 1998; 36: 193-199.

    Google Scholar 

  42. Kauppinen R, Sintonen H, Tukiainen H. One-year economic evaluation ofintensive vs conventional patient education and supervision for self-management of new asthmatic patients. Respir Med 1998; 92: 300-307.

    Google Scholar 

  43. Lönnqvist J, Sintonen H, Syvälahti E, et al. Antidepressant efficacy and quality of life in depression: A double-blind study with moclobemide and fluoxetine. Acta Psychiatr Scand 1994; 89: 363-369.

    Google Scholar 

  44. Lönnqvist J, Sihvo S, Syvälahti E, et al. Moclobemide and fluoxetine in the prevention ofrelapses following acute treatment ofdepressio n. Acta Psychiatr Scand 1995; 91: 189-194.

    Google Scholar 

  45. Rissanen P, Aro S, Slätis P, Sintonen H, Paavolainen P. Health and quality of life before and after hip or knee arthroplasty. J Arthroplasty 1995; 10: 169-175.

    Google Scholar 

  46. Rissanen P, Aro S, Sintonen H, Slätis P, Paavolainen P. Quality of life and functional ability in hip and knee replacements: a prospective study. Qual Life Res 1996; 5: 56-64.

    Google Scholar 

  47. Rissanen P, Aro S, Sintonen H, et al. Costs and cost-effectiveness in hip and knee replacements. A prospective study. Int J Technol Assess Health Care 1997; 13: 575-588.

    Google Scholar 

  48. Boyle MH, Torrance GW. Developing multiattribute health indexes. Med Care 1984; 22: 1045-1057.

    Google Scholar 

  49. Torrance GW, Boyle MH, Horwood SP. Application of multi-attribute utility theory to measure social preferences for health states. Oper Res 1982; 30: 1043-1069.

    Google Scholar 

  50. SPSS Inc. SPSS Base 9._0 Users Guide. Chicago: SPSS Inc., 1999.

    Google Scholar 

  51. Greene WH. Econometric Analysis. Upper Saddle River: Prentice-Hall International, 1993.

    Google Scholar 

  52. Maddala GS. Limited-Dependent and Qualitative Variables in Econometrics. New York: Cambridge University Press, 1997.

    Google Scholar 

  53. Greene WH. LIMDEP version 7._0 User's Manual. Revised edition. Plainview: Econometric Software Inc., 1998.

    Google Scholar 

  54. Sintonen H. Outcome measurement in acid-related diseases. Pharmaco Economics 1994; 5(Suppl. 3): 17-26.

    Google Scholar 

  55. The Diabetes Control and Complications Trial Research Group. The effect ofintensive treatment ofdiabetes on the development and progression oflong-ter m complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-986.

    Google Scholar 

  56. Hahl J, Simell T, Ilonen J, Knip M, Simell O. Costs of predicting IDDM. Diabetologia 1998; 41: 79-85.

    Google Scholar 

  57. Kupila A, Muona P, Simell T, et al. Feasibility ofgenetic and immunological prediction ofType I diabetes in a population-based birth cohort. Diabetologia 2001; 44: 290-297.

    Google Scholar 

  58. Reimers JI, Andersen HU, Pociot F. Nicotinamide and prevention ofinsulin-depende nt diabetes mellitus. Rationale, effects, toxicology and clinical experiences. ENDIT Group. Ugeskr Laeger 1994; 156: 461-465.

    Google Scholar 

  59. The DPT-1 Study Group. The diabetes prevention trial-type 1 diabetes (DPT-1): Progress report. Autoimmunity 1995; 21

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Economics, Turku School of Economics and Business Administration, Turku, Finland

    J. Hahl

  2. Research and Development Centre, Social Insurance Institution, Turku, Finland

    H. Hämäläinen

  3. Department of Public Health, University of Helsinki, Helsinki, Finland

    H. Sintonen

  4. Department of Pediatrics, University of Turku, Turku, Finland

    T. Simell

  5. National Public Health Institute, Helsinki, Finland

    S. Arinen

  6. Department of Pediatrics, University of Turku, Turku, Finland

    O. Simell

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Hahl, J., Hämäläinen, H., Sintonen, H. et al. Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications. Qual Life Res 11, 427–436 (2002). https://doi.org/10.1023/A:1015684100227

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