Sundaram Murali, Kavookjian Jan, Patrick Julie Hicks, Miller Lesley-Ann, Madhavan S Suresh, Scott Virginia Ginger
Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, 1122-B, R.C. Byrd Health Sciences Center, 9510, Morgantown, WV 26506, USA.
Qual Life Res. 2007 Mar;16(2):165-77. doi: 10.1007/s11136-006-9105-0. Epub 2006 Oct 11.
This study examines relationships between patient reported outcomes (PROs) and clinical outcomes in Type 2 diabetes mellitus (T2DM). Patients at the outpatient clinics of a university hospital completed measures of generic health status (SF-12), diabetes-specific quality of life (Audit of Diabetes Dependent Quality of Life - ADDQoL), and depressive symptoms (Center for Epidemiologic Studies Depression - CES-D). Patient reported data were merged with a retrospective collection of clinical and utilization data, including HbA1C, from electronic medical records. A Charlson comorbidity score, diabetes complications score, BMI, and total number of ER and hospital visits were calculated. Usable response rate was 44.3% (n = 385). Patients were dichotomized into glycemic control levels based on the ADA recommended A1C level < 7.0, vs. >or= 7.0. The ADDQoL, PCS-12, and MCS-12 scores were separately examined as dependent variables using hierarchical regression models, with glycemic control as the primary explanatory variable, and controlling for demographics and clinical variables including comorbidities and complications. Glycemic control was not a significant predictor in any regression model. Obesity was a significant predictor leading to poorer PCS-12 and MCS-12 scores, while depressive symptoms significantly resulted in lower PCS-12, MCS-12 and ADDQoL scores. These and other factors related to self-management behaviors may contribute to a greater understanding of how to intervene with patients with T2DM. The use of such PROs alongside biomedical measures such as A1C is recommended.
本研究探讨了2型糖尿病（T2DM）患者报告结局（PROs）与临床结局之间的关系。大学医院门诊患者完成了一般健康状况测量（SF - 12）、糖尿病特异性生活质量测量（糖尿病相关生活质量评估 - ADDQoL）以及抑郁症状测量（流行病学研究中心抑郁量表 - CES - D）。患者报告的数据与从电子病历中回顾性收集的临床和使用数据（包括糖化血红蛋白A1C）进行了合并。计算了查尔森合并症评分、糖尿病并发症评分、体重指数以及急诊和住院就诊总数。有效应答率为44.3%（n = 385）。根据美国糖尿病协会推荐的糖化血红蛋白A1C水平<7.0与≥7.0，将患者分为血糖控制水平两组。使用分层回归模型，分别将ADDQoL、PCS - 12和MCS - 12评分作为因变量进行检验，以血糖控制作为主要解释变量，并控制人口统计学和临床变量，包括合并症和并发症。在任何回归模型中，血糖控制都不是显著的预测因素。肥胖是导致PCS - 12和MCS - 12评分较差的显著预测因素，而抑郁症状显著导致PCS - 12、MCS - 12和ADDQoL评分降低。这些以及与自我管理行为相关的其他因素可能有助于更深入地了解如何干预T2DM患者。建议将此类PROs与糖化血红蛋白A1C等生物医学指标一起使用。
