Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.
Indian Institute of Public Health Bhubaneswar, Bhubaneswar, Odisha, India.
Prim Health Care Res Dev. 2020 Apr 6;21:e9. doi: 10.1017/S1463423620000055.
Health-related quality of life (HRQL) is an important outcome for chronic diseases such as diabetes mellitus that is associated with complications, comorbidities, and lifelong care.
The present study aims to explore the impact of comorbidities on the different dimensions of HRQL among type 2 diabetic patients attending primary care.
A total of 912 type 2 diabetic patients attending primary care centers in India were assessed using a predesigned and pretested questionnaire - Diabetes Comorbidity Evaluation Tool in Primary Care. The HRQL was measured by physical and mental health summary scores [physical component summary (PCS) and mental component summary (MCS)] of the Short Form Health Survey 12. The associations of sociodemographic variables and clinical variables with PCS and MCS were assessed, and a minimal difference of 5 in the scores (on a scale of 0-100) was kept as clinically relevant difference for this study. Mean differences in mental (MCS) and physical (PCS) scores of quality of life by number and type of comorbid conditions in type 2 diabetic patients were calculated.
The presence of comorbid conditions was associated with lower scores of PCS and MCS (P < 0.001). Significant reduction in HRQL was found with increase in number of comorbid conditions, and negative association was established between the number of comorbidities and the PCS (r = -0.25, P < 0.0001) and MCS scores (r = -0.21, P < 0.0001). Among comorbidities, acid peptic disease, chronic lung disease, visual impairment, depression, and stroke had significantly and clinically relevant reduced scores. Duration of diabetes, use of insulin, and obesity were also associated with poor HRQL.
Comorbidities considerably impair the HRQL among type 2 diabetic patients. National programs designed for diabetes management should also take into account the challenges of coexisting chronic conditions and its substantial effect on HRQL.
健康相关生活质量（HRQL）是糖尿病等慢性病的一个重要结果，它与并发症、合并症和终身护理有关。
本研究旨在探讨合并症对接受初级保健的 2 型糖尿病患者 HRQL 不同维度的影响。
共纳入印度 912 名接受初级保健中心治疗的 2 型糖尿病患者，采用预先设计和预测试的问卷-初级保健中的糖尿病合并症评估工具进行评估。使用健康调查简表 12 项的身心健康综合评分（PCS 和 MCS）来衡量 HRQL。评估社会人口统计学变量和临床变量与 PCS 和 MCS 的相关性，并将评分（0-100 分制）的 5 分差异作为本研究的临床相关差异。计算 2 型糖尿病患者合并症数量和类型对生活质量心理（MCS）和生理（PCS）评分的影响。
合并症的存在与 PCS 和 MCS 评分较低有关（P < 0.001）。随着合并症数量的增加，HRQL 显著下降，并且合并症数量与 PCS（r = -0.25，P < 0.0001）和 MCS 评分（r = -0.21，P < 0.0001）呈负相关。在合并症中，酸相关疾病、慢性肺病、视力障碍、抑郁和中风与明显和具有临床意义的评分降低相关。糖尿病的病程、胰岛素的使用和肥胖也与较差的 HRQL 相关。
合并症极大地损害了 2 型糖尿病患者的 HRQL。为糖尿病管理而设计的国家计划也应考虑到共存的慢性疾病的挑战及其对 HRQL 的重大影响。
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