Maddigan Sheri L, Majumdar Sumit R, Toth Ellen L, Feeny David H, Johnson Jeffrey A
Institute of Health Economics, Edmonton, AB, Canada.
Health Qual Life Outcomes. 2003 Dec 15;1:78. doi: 10.1186/1477-7525-1-78.
Diabetes is a chronic medical condition accompanied by a considerable health-related quality of life (HRQL) burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes.
The RAND-12 physical and mental health composites (PHC and MHC, respectively) and Health Utilities Index Mark 3 (HUI3) were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics.
The PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p < 0.05). Individuals treated with insulin had lower scores on the vision, emotion and pain attributes of the HUI3 than individuals managed with oral medication or diet. The PHC, MHC, pain attribute and overall score on the HUI3 captured substantial decrements in HRQL associated with absenteeism from work due to diabetes, while the burden associated with emergency room utilization for diabetes was seen in the PHC and HUI3 pain attribute.
We concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes.
糖尿病是一种慢性疾病，伴随着相当大的与健康相关的生活质量（HRQL）负担。本分析的目的是使用HRQL的通用测量方法来描述与2型糖尿病不同严重程度相关的HRQL缺陷。
372名受试者自行完成了兰德12项生理和心理健康综合指标（分别为PHC和MHC）以及健康效用指数第3版（HUI3），这些受试者参与了一项前瞻性对照研究，该研究旨在干预改善农村社区2型糖尿病患者的护理。采用协方差分析根据疾病严重程度和血糖控制情况评估HRQL的差异。疾病严重程度根据治疗强度、急诊室就诊次数和 specifically attributable to diabetes工作缺勤情况来定义。为控制潜在的混杂因素，分析针对重要的社会人口统计学和临床特征进行了调整。
与仅采用饮食治疗的个体相比，接受胰岛素治疗的个体的PHC和MHC显著更低（PHC：41.01对45.11，MHC：43.23对47.00，p<0.05）。接受胰岛素治疗的个体在HUI3的视力、情绪和疼痛属性方面的得分低于接受口服药物或饮食治疗的个体。PHC、MHC、疼痛属性和HUI3的总体得分反映出与糖尿病导致的工作缺勤相关的HRQL大幅下降，而糖尿病急诊室利用相关的负担在PHC和HUI3疼痛属性中可见。
我们得出结论，HRQL的通用测量方法捕捉到了与2型糖尿病更严重疾病相关的缺陷。
