Wan Eric Y F, Fung Colman S C, Choi Edmond P H, Wong Carlos K H, Chan Anca K C, Chan Karina H Y, Lam Cindy L K
Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F., 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong.
School of Nursing, The University of Hong Kong, 4/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
Qual Life Res. 2016 Nov;25(11):2957-2965. doi: 10.1007/s11136-016-1324-4. Epub 2016 Jun 14.
This study aimed to identify the predictors of decline in health-related quality of life (HRQOL) in Chinese patients with type 2 diabetes mellitus (T2DM).
A prospective longitudinal observational study was conducted on 1826 Chinese T2DM patients managed in public primary care setting. HRQOL was measured at baseline, 1 and 2 years by the Short Form-12 Health Survey version 2 (SF-12v2) and Chinese (HK) Short Form-6 Dimensions (SF-6D). Linear mixed effect models with forward stepwise method were performed to select the factors associated with SF-12v2 physical (PCS) and mental component summary (MCS) scores and SF-6D value.
Over a 2-year observation period, the HRQOL (PCS: -0.626; MCS: -1.869; and SF-6D: -0.017 per year) scores decreased significantly with time. Female, unmarried, current smoker, no regular exercise, obesity, comorbid hypertension, chronic kidney disease (CKD) or cardiovascular disease (CVD) and insulin use were predictors of one or more poorer HRQOL scores after 12 or 24 months. Older age had a negative impact on PCS score and SF-6D value, but had a positive impact on MCS score.
The HRQOL of Chinese T2DM patients under primary care declined significantly over time. Obesity, smoking and no regular exercise were found to be modifiable risk factors of the decline in HRQOL in T2DM, which strengthened the importance of these lifestyle changes in diabetes care. More attention should be given to T2DM patients who are female, older, unmarried, or on anti-hypertensive drugs or insulin, or have comorbid hypertension, CKD or CVD in minimizing the negative impact of illness on their life.
本研究旨在确定中国2型糖尿病（T2DM）患者健康相关生活质量（HRQOL）下降的预测因素。
对1826例在公共基层医疗环境中管理的中国T2DM患者进行了一项前瞻性纵向观察研究。在基线、1年和2年时，采用简明健康调查简表第2版（SF-12v2）和中国（香港）简明健康调查6维度（SF-6D）对HRQOL进行测量。采用向前逐步法的线性混合效应模型来选择与SF-12v2身体（PCS）和精神成分汇总（MCS）得分以及SF-6D值相关的因素。
在2年的观察期内，HRQOL得分（PCS：-0.626；MCS：-1.869；SF-6D：每年-0.017）随时间显著下降。女性（未结婚）、当前吸烟者、无规律运动、肥胖、合并高血压、慢性肾脏病（CKD）或心血管疾病（CVD）以及使用胰岛素是12或24个月后一个或多个HRQOL得分较差的预测因素。年龄较大对PCS得分和SF-6D值有负面影响，但对MCS得分有正面影响。
基层医疗环境下中国T2DM患者的HRQOL随时间显著下降。肥胖、吸烟和无规律运动被发现是T2DM患者HRQOL下降的可改变风险因素，这强化了这些生活方式改变在糖尿病护理中的重要性。对于女性、年龄较大、未婚、正在服用抗高血压药物或胰岛素、或合并高血压、CKD或CVD的T2DM患者，应给予更多关注，以尽量减少疾病对其生活的负面影响。
